# KNOX-WINAMAC COMM. HLTH CTRS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KNOX-WINAMAC COMMUNITY HEATH CENTERS, INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1184922833
- **Legal business name:** KNOX-WINAMAC COMMUNITY HEATH CENTERS, INC
- **Authorized official:** TRACEY SHORTER (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (574) 772-6030

## Contact information

- **Practice address:** 105 N. BROADWAY, SAN PIERRE, IN 46374
- **Practice address phone:** (219) 828-3300
- **Practice address fax:** (219) 828-3500
- **Mailing address:** PO BOX 338, 121 E. PEACL STREET, WINAMAC, IN 46996
- **Mailing address phone:** (574) 946-6196
- **Mailing address fax:** (574) 946-7051

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 01021497A | IN | Yes |

## Other

- **Enumeration date:** 03/04/2011
- **Last updated:** 03/04/2011