Organization
CITIZENS HEALTH CORPORATION
Active
Other names
CITIZENS HEALTH
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RON GIBSON (CEO)
(317) 396-0279
Entity
Organization
Contact information
Practice address
1650 N COLLEGE AVE, INDIANAPOLIS, IN 46202-1715
(317) 924-6351
(317) 927-3634
Mailing address
1650 N COLLEGE AVE, INDIANAPOLIS, IN 46202-1715
(317) 924-6351
(317) 927-3634
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
50000856A
IN
3336C0002X
Clinic Pharmacy
60003640A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100196020A
—
IN
05
—
100196020B
—
IN
05
—
100297090A
—
IN
01
—
1524758
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/13/2006
Last updated
12/27/2012
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