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General NPI Number Information
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NPI Number | 1871582163
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH CENTER OF SEIA, INC
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 03/17/2008
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Provider Practice Location 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 | 319-752-5540
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Fax | 319-752-4096
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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 | 319-752-5540
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Fax | 319-752-4096
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Authorized Official
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Title or Position | CEO
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Name | RON 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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 08186
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License Number State | IA
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