Provider Demographics
NPI:1376974527
Name:WABASH VALLEY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:WABASH VALLEY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:CIANCONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-240-6056
Mailing Address - Street 1:1436 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-1648
Mailing Address - Country:US
Mailing Address - Phone:812-232-7447
Mailing Address - Fax:
Practice Address - Street 1:1436 LOCUST ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1648
Practice Address - Country:US
Practice Address - Phone:812-232-7447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201168600AMedicaid