Provider Demographics
NPI:1972675270
Name:COMMUNITY HELATH CENTER OF JACKSON COUNTY
Entity Type:Organization
Organization Name:COMMUNITY HELATH CENTER OF JACKSON COUNTY
Other - Org Name:INDIANA HEALTH CENTERS SEYMOUR
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-576-1335
Mailing Address - Street 1:113 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2176
Mailing Address - Country:US
Mailing Address - Phone:812-524-8388
Mailing Address - Fax:812-524-8445
Practice Address - Street 1:113 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2176
Practice Address - Country:US
Practice Address - Phone:812-524-8388
Practice Address - Fax:812-524-8445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ113150Medicare ID - Type Unspecified