Provider Demographics
NPI:1649526773
Name:KNOX COMMUNITY HEALTH CENTER NFP
Entity type:Organization
Organization Name:KNOX COMMUNITY HEALTH CENTER NFP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:309-344-2224
Mailing Address - Street 1:1361 W FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2436
Mailing Address - Country:US
Mailing Address - Phone:309-344-2225
Mailing Address - Fax:309-344-2230
Practice Address - Street 1:1361 W FREMONT ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2436
Practice Address - Country:US
Practice Address - Phone:309-344-2225
Practice Address - Fax:309-344-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)