| Chcjc Annex | |
|
120 Saint Louis Ave Seymour IN 47274-2304 | |
| (812) 405-1857 | |
| (844) 397-1315 |
| Full Name | Chcjc Annex |
|---|---|
| Speciality | Clinic/Center |
| Location | 120 Saint Louis Ave, Seymour, Indiana |
| Authorized Official Name and Position | Tracy J Nagel (CFO) |
| Authorized Official Contact | 3175761335 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chcjc Annex 8003 Castleway Dr Indianapolis IN 46250-1946 Ph: (317) 576-1335 | Chcjc Annex 120 Saint Louis Ave Seymour IN 47274-2304 Ph: (812) 405-1857 |
| NPI Number | 1124434469 |
|---|---|
| Provider Enumeration Date | 07/08/2014 |
| Last Update Date | 03/17/2023 |
| Medicare PECOS PAC ID | 3971599473 |
|---|---|
| Medicare Enrollment ID | O20141016000443 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124434469 | NPI | - | NPPES |
| 100071250 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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