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General NPI Number Information
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NPI Number | 1376974527
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Entity Type | Organization
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Legal Business Name | WABASH VALLEY HEALTH CENTER, INC.
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 1436 LOCUST ST
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City | TERRE HAUTE
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State | IN
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Zip | 47807-1648
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Country | US
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Telephone | 812-232-7447
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Fax |
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Provider Business Mailing Address
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Address Line | 1436 LOCUST ST
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City | TERRE HAUTE
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State | IN
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Zip | 47807-1648
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Country | US
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Telephone | 812-232-7447
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF THE BOARD OF DIRECTORS
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Name | MR. PETER C. CIANCONE
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Credential |
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Telephone | 812-240-6056
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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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