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General NPI Number Information
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NPI Number | 1689653982
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Entity Type | Organization
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Legal Business Name | CITIZENS HEALTH CORPORATION
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 12/27/2012
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Provider Practice Location Address
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Address Line | 1650 N COLLEGE AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-1715
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Country | US
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Telephone | 317-924-6351
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Fax | 317-927-3634
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Provider Business Mailing Address
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Address Line | 1650 N COLLEGE AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-1715
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Country | US
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Telephone | 317-924-6351
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Fax | 317-927-3634
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Authorized Official
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Title or Position | CEO
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Name | MR. RON GIBSON
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Credential |
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Telephone | 317-396-0279
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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 | 50000856A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 60003640A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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