Provider Demographics
NPI:1700816683
Name:ECHO COMMUNITY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:ECHO COMMUNITY HEALTH CARE, INC.
Other - Org Name:ECHO WOODSON JOHN STREET HEALTH CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SANDEE
Authorized Official - Middle Name:E
Authorized Official - Last Name:STRADER-MCMILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-421-7489
Mailing Address - Street 1:315 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1252
Mailing Address - Country:US
Mailing Address - Phone:812-421-7489
Mailing Address - Fax:812-421-7497
Practice Address - Street 1:501 JOHN STREET
Practice Address - Street 2:SUITE 12
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-2705
Practice Address - Country:US
Practice Address - Phone:812-436-0224
Practice Address - Fax:812-436-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QF0400X261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200079040CMedicaid
IN151820Medicare Oscar/Certification
IN637650Medicare PIN