NPIMap

Organization Active NPI

Wabash Valley Health Center, Inc.

Doing business as St. Ann Clinic, St. Ann Dental Services, St. Ann Community Outreach Se

  • Clinic/Center
  • Terre Haute, IN
National Provider Identifier
1891044681
Registry record updated Jun 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
WABASH VALLEY HEALTH CENTER, INC.
Doing business as
St. Ann Clinic, St. Ann Dental Services, St. Ann Community Outreach Se
Practice address
1436 Locust Street
Terre Haute, IN 47807-1648
Phone
(812) 232-7447
Fax
(812) 232-6962
NPI assigned
Sep 7, 2012
Last updated
Jun 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2020

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

Authorized official

Name
Mr. Peter Cook Ciancone
Title
President of the Board of Directors
Phone
(812) 240-6056

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

1436 Locust Street
Terre Haute, IN 47807-1648

Mailing address

1436 Locust Street
Terre Haute, IN 47807-1648
Phone (812) 232-7447

Other names 1

  • St. Ann Clinic, St. Ann Dental Services, St. Ann Community Outreach Se Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130204000433 IN Part B Supplier - Clinic/Group Practice 4880848530 Receives reassigned benefits from 14 practitioners
Practice locations: Terre Haute, IN

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1346976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593388800000",
    "number": "1891044681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1436 LOCUST STREET",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478071648",
            "telephone_number": "812-232-7447",
            "fax_number": "812-232-6962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1436 LOCUST STREET",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478071648",
            "telephone_number": "812-232-7447",
            "fax_number": "812-232-6962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WABASH VALLEY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-07",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A",
        "authorized_official_last_name": "CIANCONE",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "COOK",
        "authorized_official_title_or_position": "PRESIDENT OF THE BOARD OF DIRECTORS",
        "authorized_official_telephone_number": "812-240-6056",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Ann Clinic, St. Ann Dental Services, St. Ann Community Outreach Se",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Ann Clinic, St. Ann Dental Services, St. Ann Community Outreach Se",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Terre Haute, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.