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COMMUNITY HEALTH & WELLNESS PARTNERS OF LOGAN COUNTY NPI 1962828293


NPI Information

NPI: 1962828293
Provider Name: COMMUNITY HEALTH & WELLNESS PARTNERS OF LOGAN COUNTY

Doing Business As: INDIAN LAKE COMMUNITY HEALTH CENTER

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 36D2077415

Address:
8200 STATE ROUTE 366
SUITE NO. 1
RUSSELLS POINT, OH
ZIP 43348
Phone: (937) 599-1411
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COMMUNITY HEALTH & WELLNESS PARTNERS OF LOGAN COUNTY is a federally qualified health center (fqhc) clinic center in Russells Point, OH. COMMUNITY HEALTH & WELLNESS PARTNERS OF LOGAN COUNTY NPI is 1962828293. The provider is registered as an organization entity type.
The provider Is Doing Business As Indian Lake Community Health Center.

The provider's business location address is:

8200 STATE ROUTE 366
SUITE NO. 1
RUSSELLS POINT, OH
ZIP 43348-670
Phone: (937) 599-1411
Fax: (937) 599-4128

The provider's authorized official is Tara D Bair .
The authorized official title is President/ceo and has the following contact phone number (937) 887-1013.

The CLIA number assigned to this NPI record is 36D2077415 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/11/2014 and was last updated on 12/12/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1361046MEDICARE OSCAR/CERTIFICATIONOHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024
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