Organization Name: | COMMUNITY HEALTH CLINICS INC |
NPI Number: | 1578574521 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ERWIN B TUEBER (EXECUTIVE DIRECTOR) |
Mailing Address: | 150 2nd Avenue Melba |
State: | ID US |
Postal Code: | 83641 |
Phone Number: | 2084951011 |
Fax Number: | 2084951012 |
NPI Enumeration Date: | 08/11/2006 |
NPI Last Update Date: | 11/05/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |