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Organization

COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ANTONIO FLORES CEO (CEO)
(319) 768-5858
Entity
Organization

Contact information

Practice address
1706 WEST AGENCY ROAD, WEST BURLINGTON, IA 52655
(319) 768-5858
(319) 752-4653
Mailing address
1706 WEST AGENCY ROAD, WEST BURLINGTON, IA 52655
(319) 768-5858
(319) 752-4653

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35097
IA
207R00000X
Internal Medicine Physician
37355
IA
208000000X
Pediatrics Physician
17758
IA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
363A00000X
Physician Assistant
000671
IA
363L00000X
Nurse Practitioner
A045847
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0288175
IA
01
35732
BC/BS OF IOWA
IA
05
506089432
MO
Enumeration date
07/08/2005
Last updated
01/25/2023
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