Provider Demographics
NPI:1972853083
Name:RIVER HILLS COMMUNITY HEALTH CENTER KEOKUK CO CLINIC
Entity Type:Organization
Organization Name:RIVER HILLS COMMUNITY HEALTH CENTER KEOKUK CO CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-684-6896
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-0458
Mailing Address - Country:US
Mailing Address - Phone:641-684-6896
Mailing Address - Fax:641-226-5759
Practice Address - Street 1:100 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:IA
Practice Address - Zip Code:52585-9212
Practice Address - Country:US
Practice Address - Phone:319-456-2045
Practice Address - Fax:319-456-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-16
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
161848Medicare Oscar/Certification