| Community Health Care, Inc. Outreach Clinic | |
|
902 W 4th St Davenport IA 52802-3507 | |
| (563) 336-3000 | |
| (563) 336-3125 |
| Full Name | Community Health Care, Inc. Outreach Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 902 W 4th St, Davenport, Iowa |
| Authorized Official Name and Position | Thomas J Bowman (CEO) |
| Authorized Official Contact | 5633363000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Health Care, Inc. Outreach Clinic 500 W River Dr Davenport IA 52801-1014 Ph: (563) 336-3000 | Community Health Care, Inc. Outreach Clinic 902 W 4th St Davenport IA 52802-3507 Ph: (563) 336-3000 |
| NPI Number | 1124008214 |
|---|---|
| Provider Enumeration Date | 01/17/2006 |
| Last Update Date | 03/25/2024 |
| Medicare PECOS PAC ID | 9830008895 |
|---|---|
| Medicare Enrollment ID | O20240516001019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124008214 | NPI | - | NPPES |
| 113373 | Other | IA | UNITED HEALTHCARE |
| 13238 | Other | IA | IA BC/BS GROUP# |
| 0080200 | Medicaid | IA | |
| 8122859 | Other | IL | IL BC/BS |
| ========= | Medicaid | IL | |
| CP8565 | Other | IA | RAILROAD MEDICARE GROUP # |
| ========= | Other | IA | BILLING TAX ID# FOR CHC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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