| Community Health Care - Rock Island | |
|
2750 11th St Rock Island IL 61201-5216 | |
| (563) 327-2100 | |
| (563) 327-2102 |
| Full Name | Community Health Care - Rock Island |
|---|---|
| Speciality | Clinic/Center |
| Location | 2750 11th St, Rock Island, 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 - Rock Island 500 W River Dr Davenport IA 52801-1014 Ph: (563) 336-3000 | Community Health Care - Rock Island 2750 11th St Rock Island IL 61201-5216 Ph: (563) 327-2100 |
| NPI Number | 1598759292 |
|---|---|
| Provider Enumeration Date | 09/08/2005 |
| Last Update Date | 04/18/2013 |
| Medicare PECOS PAC ID | 9830008895 |
|---|---|
| Medicare Enrollment ID | O20030408000045 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598759292 | NPI | - | NPPES |
| 92912 | Other | IA | IA BC/BS GROUP # |
| 14D1020507 | Other | IL | CLIA # |
| 113373 | Other | IL | UNITED HEALTHCARE |
| 0568980 | Medicaid | IA | |
| CP8565 | Other | IL | RAILROAD MEDICARE GROUP # |
| 8122859 | Other | IL | IL BC/BS GROUP # |
| I12619 | Other | IA | INDEPENTANT LAB |
| 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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