NPIMap

Organization Active NPI

Boone County Community Health Clinic, Inc

  • Community Health Clinic/Center
  • Lebanon, IN
National Provider Identifier
1962681734
Registry record updated Feb 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
71000784B Issued in IN
Legal business name
BOONE COUNTY COMMUNITY HEALTH CLINIC, INC
Practice address
416 W Camp St
Lebanon, IN 46052-1799
Phone
(765) 483-4469
NPI assigned
Oct 30, 2007
Last updated
Feb 4, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2014

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

Authorized official

Name
Mrs. Bambi McQuade-Jones, DNP, FNP-CNPI 1548390842
Title
Executive Director
Phone
(765) 483-4469

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 71000784B IN Primary

Addresses

Primary practice location

416 W Camp St
Lebanon, IN 46052-1799

Mailing address

416 W Camp St
Lebanon, IN 46052-1799
Phone (765) 483-4469

Other identifiers 3

IdentifierTypeStateIssuer
100063430MedicaidIN
200401120AMedicaidIN
200432840MedicaidIN

National Provider Directory

National Provider Directory

Locations

404 W Camp St
Lebanon, IN 46052
Phone (765) 483-4469

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391472000000",
    "number": "1962681734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 W CAMP ST",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460521799",
            "telephone_number": "765-483-4469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 W CAMP ST",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460521799",
            "telephone_number": "765-483-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOONE COUNTY COMMUNITY HEALTH CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-30",
        "last_updated": "2014-02-04",
        "status": "A",
        "authorized_official_last_name": "MCQUADE-JONES",
        "authorized_official_first_name": "BAMBI",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "765-483-4469",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DNP, FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "IN",
            "license": "71000784B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100063430",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200401120A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200432840",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2014; 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.