Healthcare Provider Details

I. General information

NPI: 1295705622
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 POLK ST
WARSAW IL
62379-1033
US

IV. Provider business mailing address

1706 WEST AGENCY ROAD
WEST BURLINGTON IA
52655
US

V. Phone/Fax

Practice location:
  • Phone: 217-256-3013
  • Fax: 319-753-2301
Mailing address:
  • Phone: 319-768-5858
  • Fax: 319-753-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. APRIL K SCHNEDLER
Title or Position: LEAD BILLING COORDINATOR
Credential:
Phone: 319-768-5809