Provider Demographics
NPI:1093044331
Name:COMMUNITY ACTION COMMITTEE OF PIKE COUNTY
Entity Type:Organization
Organization Name:COMMUNITY ACTION COMMITTEE OF PIKE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-289-2371
Mailing Address - Street 1:941 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-9757
Mailing Address - Country:US
Mailing Address - Phone:740-289-2371
Mailing Address - Fax:740-289-3545
Practice Address - Street 1:717 5TH ST
Practice Address - Street 2:PORTSMOUTH FAMILY HEALTH CENTER
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4007
Practice Address - Country:US
Practice Address - Phone:740-354-6605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3051754Medicaid
361953OtherCMS FQHC CERTIFICATION NUMBER
1447349956OtherINDIVIDUAL PROVIDERS NPI #