Organization
KNOX-WINAMAC COMM. HLTH CTRS, INC.
Active
Parent organization
KNOX-WINAMAC COMMUNITY HEATH CENTERS, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
KNOX-WINAMAC COMMUNITY HEATH CENTERS, INC
Authorized official
TRACEY SHORTER (EXECUTIVE DIRECTOR)
(574) 772-6030
Entity
Organization
Contact information
Practice address
105 N. BROADWAY, SAN PIERRE, IN 46374
(219) 828-3300
(219) 828-3500
Mailing address
PO BOX 338, 121 E. PEACL STREET, WINAMAC, IN 46996
(574) 946-6196
(574) 946-7051
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01021497A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100210550A
—
IN
Enumeration date
03/04/2011
Last updated
03/04/2011
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