Provider Demographics
NPI:1770668030
Name:MADISON COUNTY COMMUNITY HEALTH CENTERS INC
Entity Type:Organization
Organization Name:MADISON COUNTY COMMUNITY HEALTH CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-641-0255
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:1547 OHIO AVENUE
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016
Mailing Address - Country:US
Mailing Address - Phone:765-641-0255
Mailing Address - Fax:765-641-0256
Practice Address - Street 1:1547 OHIO AVENUE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016
Practice Address - Country:US
Practice Address - Phone:765-641-0255
Practice Address - Fax:765-641-0256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200271310Medicaid
IN200271310Medicaid