NPIMap

Organization Active NPI

Knox-Winamac Comm. HLTH CTRS, Inc.

  • Family Medicine Physician
  • San Pierre, IN
National Provider Identifier
1184922833
Registry record updated Mar 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01021497A Issued in IN
Legal business name
KNOX-WINAMAC COMM. HLTH CTRS, INC.
Practice address
105 N. Broadway
San Pierre, IN 46374
Phone
(219) 828-3300
Fax
(219) 828-3500
NPI assigned
Mar 4, 2011
Last updated
Mar 4, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
KNOX-WINAMAC COMMUNITY HEATH CENTERS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 4, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tracey Shorter
Title
Executive Director
Phone
(574) 772-6030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01021497A IN Primary

Addresses

Primary practice location

105 N. Broadway
San Pierre, IN 46374

Mailing address

PO Box 338
121 E. Peacl Street
Winamac, IN 46996
Phone (574) 946-6196

Other identifiers 1

IdentifierTypeStateIssuer
100210550AMedicaidIN

National Provider Directory

National Provider Directory
Tax ID family
Knox Winamac HLTH CNTR Inc5 organizations share this tax ID, including this one
Part of
Knox Winamac HLTH CNTR Inc

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

105 N Broadway St
San Pierre, IN 46374
Phone (574) 828-3020

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1299196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299196800000",
    "number": "1184922833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 338",
            "address_2": "121 E. PEACL STREET",
            "city": "WINAMAC",
            "state": "IN",
            "postal_code": "46996",
            "telephone_number": "574-946-6196",
            "fax_number": "574-946-7051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 N. BROADWAY",
            "city": "SAN PIERRE",
            "state": "IN",
            "postal_code": "46374",
            "telephone_number": "219-828-3300",
            "fax_number": "219-828-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNOX-WINAMAC COMM. HLTH CTRS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KNOX-WINAMAC COMMUNITY HEATH CENTERS, INC",
        "enumeration_date": "2011-03-04",
        "last_updated": "2011-03-04",
        "status": "A",
        "authorized_official_last_name": "SHORTER",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "574-772-6030"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01021497A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100210550A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Pierre, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.