Provider Demographics
NPI:1295800084
Name:DUBOIS-PIKE-WARRICK ECONOMIC OPPORTUNITY COMMITTEE, INC.
Entity type:Organization
Organization Name:DUBOIS-PIKE-WARRICK ECONOMIC OPPORTUNITY COMMITTEE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:812-482-2233
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-0729
Mailing Address - Country:US
Mailing Address - Phone:812-482-2233
Mailing Address - Fax:
Practice Address - Street 1:607 3RD AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3636
Practice Address - Country:US
Practice Address - Phone:812-482-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047256A261QA0005X
IN71000939A363L00000X
IN71001316B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10783002OtherCAQH ID