Provider Demographics
NPI:1417787581
Name:COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
Entity type:Organization
Organization Name:COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-753-2300
Mailing Address - Street 1:1706 W AGENCY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1667
Mailing Address - Country:US
Mailing Address - Phone:319-313-8892
Mailing Address - Fax:319-313-8889
Practice Address - Street 1:1618 MAIN ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-3928
Practice Address - Country:US
Practice Address - Phone:319-313-8892
Practice Address - Fax:319-313-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy