Provider Demographics
NPI:1225290059
Name:COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
Other - Org Name:LOUISA COUNTY CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-753-2300
Mailing Address - Street 1:1706 W AGENCY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1667
Mailing Address - Country:US
Mailing Address - Phone:319-768-5858
Mailing Address - Fax:319-753-2301
Practice Address - Street 1:241 COLONELS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS JUNCTION
Practice Address - State:IA
Practice Address - Zip Code:52738-9702
Practice Address - Country:US
Practice Address - Phone:319-728-7402
Practice Address - Fax:319-728-7402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)