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General NPI Number Information
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NPI Number | 1083245955
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Entity Type | Organization
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Legal Business Name | KOSCIUSKO COUNTY FREE CLINIC, INC
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 7822 E. EPWORTH FOREST ROAD NORTH WEBSTER UNITED METHODIST CHURCH
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City | NORTH WEBSTER
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State | IN
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Zip | 46555
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Country | US
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Telephone | 574-834-2871
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Fax |
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Provider Business Mailing Address
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Address Line | 22 EMS C27C2 LN
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City | WARSAW
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State | IN
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Zip | 46582-9067
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Country | US
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Telephone | 574-268-1917
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KATHLEEN KOSTRO
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Credential | MPH
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Telephone | 574-268-1917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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