Organization
BOONE COUNTY COMMUNITY HEALTH CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BAMBI MCQUADE-JONES DNP, FNP-C (EXECUTIVE DIRECTOR)
(765) 483-4469
Entity
Organization
Contact information
Practice address
416 W CAMP ST, LEBANON, IN 46052-1799
(765) 483-4469
Mailing address
416 W CAMP ST, LEBANON, IN 46052-1799
(765) 483-4469
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
71000784B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100063430
—
IN
05
—
200401120A
—
IN
05
—
200432840
—
IN
Enumeration date
10/30/2007
Last updated
02/04/2014
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