Provider Demographics
NPI:1891044681
Name:WABASH VALLEY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:WABASH VALLEY HEALTH CENTER, INC.
Other - Org Name:ST. ANN CLINIC, ST. ANN DENTAL SERVICES, ST. ANN COMMUNITY OUTREACH SE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF THE BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:COOK
Authorized Official - Last Name:CIANCONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-240-6056
Mailing Address - Street 1:1436 LOCUST STREET
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:812-232-6962
Practice Address - Street 1:1436 LOCUST STREET
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:812-232-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center