MEDICARE: COMMUNITY HEALTH CARE, 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	291U00000X	Clinical Medical Laboratory
2	261QF0400X	Federally Qualified Health Center (FQHC)

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	CP8565	OTHER	IL	RAILROAD MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	113373	OTHER	IL	UNITED HEALTH CARE
2	14D1020508	OTHER	IL	CLIA
3	8122859	OTHER	IL	IL BC/BS GROUP#
4	91681	OTHER	IA	IA BC/BS GROUP #
5	I12619	OTHER	IA	INDEPENDANT LAB
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710971486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	500 W RIVER DR
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52801-1014
Country	:	US
Telephone Number	:	563-336-3000
Fax Number	:	563-336-3044

Provider Business Practice Location Address
First Line	:	1106 4TH AVE
Second Line	:
City	:	MOLINE
State	:	IL
Zip	:	61265-0000
Country	:	US
Telephone Number	:	563-327-2000
Fax Number	:	563-327-2045

Authorized Official
Title or Position	:	CEO
Name	:	THOMAS J BOWMAN
Credential	:
Telephone Number	:	563-336-3000

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	04/18/2013

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Directions to “COMMUNITY HEALTH CARE, INC. ” Practice Location

Language	Start Address	Practice Location

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