Provider Demographics
NPI:1457616393
Name:KNOX WINAMAC COMMUNITY HEALTH CENTERS, INC
Entity Type:Organization
Organization Name:KNOX WINAMAC COMMUNITY HEALTH CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-772-6030
Mailing Address - Street 1:1002 S EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-8226
Mailing Address - Country:US
Mailing Address - Phone:574-772-6030
Mailing Address - Fax:574-772-7494
Practice Address - Street 1:105 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAN PIERRE
Practice Address - State:IN
Practice Address - Zip Code:46374-9509
Practice Address - Country:US
Practice Address - Phone:574-828-3020
Practice Address - Fax:574-828-3044
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KNOX WINAMAC COMMUNITY HEALTH CENTERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)