NPIMap

Organization Active NPI

Community Health Centers of Southeastern Iowa Inc

  • Federally Qualified Health Center (FQHC)
  • Columbus City, IA
National Provider Identifier
1265618805
Registry record updated Jan 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC
Practice address
2409 Spring St
Columbus City, IA 52737-9302
Phone
(319) 728-7400
Fax
(319) 753-2301
NPI assigned
Jan 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2023

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

Authorized official

Name
Mr. Antonio Flores, CEO
Title
Ceo
Phone
(319) 758-5858

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2409 Spring St
Columbus City, IA 52737-9302

Mailing address

1706 W Agency Rd
West Burlington, IA 52655-1667
Phone (319) 768-5858

Other identifiers 2

IdentifierTypeStateIssuer
1265618805MedicaidIA
35732OtherIABLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000446 IA Part B Supplier - Clinic/Group Practice 4486562527 Receives reassigned benefits from 40 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Burlington, IA; Columbus City, IA; Keokuk, IA; West Burlington, IA
O20080215000443 IA Part A Provider - Federally Qualified Health Center (FQHC) 4486562527 Practice locations: Columbus City, IA

Federally qualified health center certification: CCN 161850

Legal name
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 16, 2008
Last certification
Apr 16, 2008
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Enrollment address
2409 Spring St
Columbus City, IA 52737-9302

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D1080205Community Health Centers of Southeastern Iowa,Inc2409 Spring Street, Columbus City, IA 52737Certificate of waiverFeb 14, 2028

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

2409 Spring St
Columbus City, IA 52737
Phone (319) 728-7400

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Suzanne Sorensen Individual Corporate DirectorBoard Member May 28, 2020
William Staats Individual Corporate Officer Mar 1, 2008
David Haden Individual Corporate DirectorBoard Member Jan 26, 2023
Joseph Douglas Individual Corporate DirectorBoard Member Apr 25, 2024
Julie a Schilling Individual Corporate OfficerBoard Member Jan 1, 2003
Delaney Richards Individual Corporate DirectorBoard Member Jan 26, 2023
Misty Cale Individual Corporate DirectorBoard Member Dec 18, 2025
Dennis Fitzgibbon Individual Corporate DirectorBoard Member Jun 26, 2025
David Selmon Individual Corporate DirectorBoard Member Sep 27, 2021
William Grimm Individual Corporate OfficerCeo Aug 1, 2024
W-2 Managing Employee Aug 1, 2024
Operational/Managerial ControlCeo Aug 1, 2024
Samuel Klein Individual Corporate DirectorBoard Member Jun 26, 2025
Jeffrey Strause Individual Corporate OfficerBoard Member Jan 25, 2018
Chuck Griffin Individual Corporate Officer Jan 1, 2016

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674604800000",
    "number": "1265618805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 W AGENCY RD",
            "city": "WEST BURLINGTON",
            "state": "IA",
            "postal_code": "526551667",
            "telephone_number": "319-768-5858",
            "fax_number": "319-753-2301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2409 SPRING ST",
            "city": "COLUMBUS CITY",
            "state": "IA",
            "postal_code": "527379302",
            "telephone_number": "319-728-7400",
            "fax_number": "319-753-2301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-14",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A",
        "authorized_official_last_name": "FLORES",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "319-758-5858",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265618805",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "35732",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus City, IA

Sources for this page

Verify at the official NPI Registry.