Provider Demographics
NPI:1023189610
Name:KNOX COUNTY IMMUNIZATION CLINIC
Entity Type:Organization
Organization Name:KNOX COUNTY IMMUNIZATION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-882-8080
Mailing Address - Street 1:701 DUBOIS ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1037
Mailing Address - Country:US
Mailing Address - Phone:812-885-8400
Mailing Address - Fax:812-882-8701
Practice Address - Street 1:328 N 2ND ST STE 100
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1353
Practice Address - Country:US
Practice Address - Phone:812-882-8080
Practice Address - Fax:812-882-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200127560Medicaid