Organization
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC
Active
Other names
Tri-State Medical Group Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTONIO FLORES CEO (CEO)
(319) 768-5858
Entity
Organization
Contact information
Practice address
951 BROADWAY ST, HAMILTON, IL 62341-1436
(217) 847-2112
(319) 753-2301
Mailing address
1706 WEST AGENCY ROAD, WEST BURLINGTON, IA 52655
(319) 768-5858
(319) 753-2301
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0563890
—
IA
01
—
3422957
BLUE CROSS BLUE SHIELD
IL
05
—
506089416
—
MO
Enumeration date
01/13/2006
Last updated
01/25/2023
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