MEDICARE: ADAMS COUNTY HEALTH CENTER 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
1	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1700100	OTHER	ID	CIGNA
2	1700101	OTHER	ID	CIGNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710915897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAMS COUNTY HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 428
Second Line	:
City	:	COUNCIL
State	:	ID
Zip	:	83612-0428
Country	:	US
Telephone Number	:	208-253-4242
Fax Number	:	208-253-6849

Provider Business Practice Location Address
First Line	:	205 N BERKLEY
Second Line	:
City	:	COUNCIL
State	:	ID
Zip	:	83612-0428
Country	:	US
Telephone Number	:	208-253-4242
Fax Number	:	208-253-6849

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DENISE A LANGSTON-GROVES
Credential	:
Telephone Number	:	208-253-4242

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	03/11/2016

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Directions to “ADAMS COUNTY HEALTH CENTER INC ” Practice Location

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