Provider Demographics
NPI:1720108541
Name:PEOPLES COMMUNITY HEALTH CLINIC, INC.
Entity Type:Organization
Organization Name:PEOPLES COMMUNITY HEALTH CLINIC, INC.
Other - Org Name:PEOPLES CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-874-3000
Mailing Address - Street 1:905 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-4407
Mailing Address - Country:US
Mailing Address - Phone:319-874-3000
Mailing Address - Fax:319-874-3489
Practice Address - Street 1:905 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-4407
Practice Address - Country:US
Practice Address - Phone:319-272-4300
Practice Address - Fax:319-272-4489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA406333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0076372Medicaid
IA1618113Medicare UPIN
IA0076372Medicaid