Organization
KNOX WINAMAC COMMUNITY HEALTH CENTERS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA R FRITZ (OFFICE MANAGER)
(574) 772-2188
Entity
Organization
Contact information
Practice address
1520 S HEATON ST, KNOX, IN 46534-2393
(574) 772-2188
(574) 772-2190
Mailing address
1520 S HEATON ST, KNOX, IN 46534-2393
(574) 772-2188
(574) 772-2190
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
50000720A
IN
261QR1300X
Rural Health Clinic/Center
50000720A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000083056
BLUE CROSS BLUE SHIELD
IN
01
—
01024309A
WALTER FRITZ, M.D. LICENS
IN
05
—
100225090
—
IN
05
—
200020860A
—
IN
05
—
200897290
—
IN
01
—
351301967
TAX ID
IN
01
—
50000720A
CORPORATION LICENSE
IN
Enumeration date
05/22/2006
Last updated
04/11/2013
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