| Community Health Care - Moline | |
|
1106 4th Ave Moline IL 61265-0000 | |
| (563) 327-2000 | |
| (563) 327-2045 |
| Full Name | Community Health Care - Moline |
|---|---|
| Speciality | Clinic/Center |
| Location | 1106 4th Ave, Moline, Illinois |
| 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 - Moline 500 W River Dr Davenport IA 52801-1014 Ph: (563) 336-3000 | Community Health Care - Moline 1106 4th Ave Moline IL 61265-0000 Ph: (563) 327-2000 |
| NPI Number | 1710971486 |
|---|---|
| Provider Enumeration Date | 09/08/2005 |
| Last Update Date | 04/18/2013 |
| Medicare PECOS PAC ID | 9830008895 |
|---|---|
| Medicare Enrollment ID | O20030408000047 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710971486 | NPI | - | NPPES |
| 113373 | Other | IL | UNITED HEALTH CARE |
| 14D1020508 | Other | IL | CLIA |
| 8122859 | Other | IL | IL BC/BS GROUP# |
| 91681 | Other | IA | IA BC/BS GROUP # |
| I12619 | Other | IA | INDEPENDANT LAB |
| 0568998 | Medicaid | IA | |
| CP8565 | Other | IL | RAILROAD MEDICARE GROUP # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| 291U00000X | Clinical Medical Laboratory | (* (Not Available)) | Secondary |
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