Provider Demographics
NPI:1629248919
Name:KNOX WINAMAC COMMUNITY HEALTH CENTERS INC
Entity Type:Organization
Organization Name:KNOX WINAMAC COMMUNITY HEALTH CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-772-6030
Mailing Address - Street 1:1002 S EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-8226
Mailing Address - Country:US
Mailing Address - Phone:574-772-6030
Mailing Address - Fax:574-772-7494
Practice Address - Street 1:1002 S EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-8226
Practice Address - Country:US
Practice Address - Phone:574-772-6030
Practice Address - Fax:574-772-7494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207Q00000X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200897290AMedicaid
IN264650AMedicare PIN
INDP8668Medicare PIN
IN200897290AMedicaid
IN264650BMedicare PIN
264650CMedicare PIN