Provider Demographics
NPI:1598896391
Name:PEOPLES COMMUNITY CLINIC INC
Entity Type:Organization
Organization Name:PEOPLES COMMUNITY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-478-4939
Mailing Address - Street 1:2909 N I H 35
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722-2304
Mailing Address - Country:US
Mailing Address - Phone:512-478-4939
Mailing Address - Fax:512-320-0702
Practice Address - Street 1:2909 N I H 35
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722-2304
Practice Address - Country:US
Practice Address - Phone:512-478-4939
Practice Address - Fax:512-320-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134775901Medicaid
TX00FX85Medicare ID - Type Unspecified