NPIMap

Organization Active NPI

Knox Winamac Community Health Centers, Inc

  • Family Medicine Physician
  • Knox, IN
National Provider Identifier
1619921558
Registry record updated Apr 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
50000720A Issued in IN
Legal business name
KNOX WINAMAC COMMUNITY HEALTH CENTERS, INC
Practice address
1520 S Heaton St
Knox, IN 46534-2393
Phone
(574) 772-2188
Fax
(574) 772-2190
NPI assigned
May 22, 2006
Last updated
Apr 11, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2013

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

Authorized official

Name
Diana R Fritz
Title
Office Manager
Phone
(574) 772-2188

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 50000720A IN
Family Medicine Physician 207Q00000X 50000720A IN Primary

Addresses

Primary practice location

1520 S Heaton St
Knox, IN 46534-2393

Mailing address

1520 S Heaton St
Knox, IN 46534-2393
Phone (574) 772-2188

Other identifiers 7

IdentifierTypeStateIssuer
100225090MedicaidIN
200020860AMedicaidIN
351301967OtherINTAX ID
200897290MedicaidIN
000000083056OtherINBLUE CROSS BLUE SHIELD
01024309AOtherINWALTER FRITZ, M.D. LICENS
50000720AOtherINCORPORATION LICENSE

National Provider Directory

National Provider Directory
Tax ID family
Knox Winamac Community Health Centers Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1520 S Heaton St
Knox, IN 46534
Phone (219) 772-2188

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365638400000",
    "number": "1619921558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 S HEATON ST",
            "city": "KNOX",
            "state": "IN",
            "postal_code": "465342393",
            "telephone_number": "574-772-2188",
            "fax_number": "574-772-2190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 S HEATON ST",
            "city": "KNOX",
            "state": "IN",
            "postal_code": "465342393",
            "telephone_number": "574-772-2188",
            "fax_number": "574-772-2190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNOX WINAMAC COMMUNITY HEALTH CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2013-04-11",
        "status": "A",
        "authorized_official_last_name": "FRITZ",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "574-772-2188"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IN",
            "license": "50000720A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "50000720A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100225090",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200020860A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "351301967",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200897290",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000083056",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WALTER FRITZ, M.D. LICENS",
            "identifier": "01024309A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATION LICENSE",
            "identifier": "50000720A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knox, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2013; 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.