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NPI Code Detail

MEDICARE: PEOPLES COMMUNITY HEALTH CLINIC, INC.

MEDICARE: PEOPLES COMMUNITY HEALTH CLINIC, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QC1500XCommunity Health Clinic/Center
2261QF0400XFederally Qualified Health Center (FQHC)IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
215689OTHERIAWELLMARK

General Provider Information

NPI Number : 1093703639
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEOPLES COMMUNITY HEALTH CLINIC, INC.
Provider Business Mailing Address
First Line : 905 FRANKLIN ST
Second Line :
City : WATERLOO
State : IA
Zip : 50703-4407
Country : US
Telephone Number : 319-874-3000
Fax Number : 319-874-3411
Provider Business Practice Location Address
First Line : 905 FRANKLIN ST
Second Line :
City : WATERLOO
State : IA
Zip : 50703-4407
Country : US
Telephone Number : 319-272-4300
Fax Number : 319-272-4321
Authorized Official
Title or Position : CEO
Name : CHRISTINE KEMP
Credential : CEO
Telephone Number : 319-874-3000
Provider Enumeration Date : 10/07/2005
Last Update Date : 10/02/2018

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