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General NPI Number Information
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NPI Number | 1225290059
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 241 COLONELS DR
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City | COLUMBUS JUNCTION
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State | IA
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Zip | 52738-9702
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Country | US
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Telephone | 319-728-7402
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Fax | 319-728-7402
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Provider Business Mailing Address
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Address Line | 1706 W AGENCY RD
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City | WEST BURLINGTON
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State | IA
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Zip | 52655-1667
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Country | US
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Telephone | 319-768-5858
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Fax | 319-753-2301
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Authorized Official
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Title or Position | CEO
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Name | RONALD W KEMP
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Credential |
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Telephone | 319-753-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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