Organization
KNOX-WINAMAC COMMUNITY HEALTH CENTERS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY SHORTER (EXECUTIVE DIRECTOR)
(574) 946-6196
Entity
Organization
Contact information
Practice address
121 E PEARL ST, WINAMAC, IN 46996-1310
(574) 946-6196
(574) 946-7051
Mailing address
121 E PEARL ST, WINAMAC, IN 46996-1310
(574) 946-6196
(574) 946-7051
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01021407A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200408280A
—
IN
Enumeration date
06/13/2006
Last updated
01/27/2011
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