Valley Professionals Community Health Center Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Clinton, IN
NPI 1972312973 · NPPES record last updated Jan 9, 2025
Key facts
- NPI
- 1972312973
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC
- Practice address
- 1792 E State Road 163
Clinton, IN 47842-7327 - Phone
- (765) 828-3241
- NPI assigned
- Jan 3, 2025
- Organization subpart
- No
Authorized official
- Name
- Terry J Warren
- Title
- President/Ceo
- Phone
- (765) 828-1003
Owners & managing parties with NPI records 1
Other NPIs on the same Medicare enrollment 9
Other NPIs with the same Medicare PAC ID 9
Corporate family (same tax ID) 6
Practitioners 92
-
Leslie Don Batty, FNP
-
Eric D. Beachy, MD
-
Misha Bennett, LCSW
-
Anna M Blevins, NP
-
Zakary Bushue, LCSW
-
Mary Alvanos Deady, LMHC
-
Robert Matthew Ehresman, M.D.
-
Sean Ewing, MD
-
Lisa Dawn Gaither, MSW, LCSW
-
Bing Wang Gale, MD
-
Victoria Gregory, DC, MS
-
Brooke R Griffin, MD
-
Jason Heck, PMHNP
-
Craig Alan Johnson, D.O.
-
Amy Lynn Joy, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN
Federally qualified health center certification: CCN C51083
- Legal name
- VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC
- Doing business as
- VPCHC - CLINTON DENTAL
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 13, 2025
- Last certification
- Mar 13, 2025
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 1792 E State Road 163
Clinton, IN 47842-7327
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Loretta Johnson |
Operational/Managerial Control | Jan 12, 2025 | |
| Terry J Warren |
Corporate Officer | Jan 20, 2025 | |
| W-2 Managing Employee | Jan 20, 2025 | ||
| Michael Miller |
Corporate Officer | Jan 20, 2025 | |
| Kristin Craig |
Corporate Officer | Jan 20, 2025 | |
| Mark Russell |
Corporate Officer | Jan 20, 2025 | |
| Daniel Hardesty |
Corporate Officer | Jan 20, 2025 | |
| Ronald Hodge |
Corporate Officer | Jan 20, 2025 | |
| Marina Wolfe |
Corporate Officer | Jan 20, 2025 | |
| Danielle M Cundiff |
Corporate Officer | Jan 20, 2025 | |
| Dawn Newnum |
Corporate Director | Jan 20, 2025 | |
| Jessica Marie Purcell |
Corporate Director | Jan 20, 2025 | |
| Jill Pastore |
Corporate Officer | Jan 20, 2025 | |
| Michael Rentfro |
Corporate Officer | Jan 20, 2025 | |
| Christopher M Williams |
Corporate Director | Jan 20, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071219000487 | IN | Part B Supplier - Clinic/Group Practice | 7618067265 |
Receives reassigned benefits from 94 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: West Terre Haute, IN; Terre Haute, IN; Rockville, IN; Clinton, IN; Crawfordsville, IN; Bloomingdale, IN; Cayuga, IN |
| O20250311000919 | IN | Part a Provider - Federally Qualified Health Center (FQHC) | 7618067265 | Practice locations: Clinton, IN |
National Provider Directory
- Tax ID family
- Valley Professionals Community Health Center Inc
Locations
1793 E State Rd 163
Clinton, IN 47842
1810 Lafayette Rd
Crawfordsville, IN 47933
Phone (765) 362-2800
1530 N 7th St
Ste 201
Terre Haute, IN 47807
Phone (812) 238-7631
4757 S 7th St
Terre Haute, IN 47802
Phone (812) 234-2289
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1792 E State Road 163
Clinton, IN 47842-7327
Mailing address
777 S Main St Ste 100
Clinton, IN 47842-2493
Phone (765) 828-1003
Other names
- VPCHC-Clinton Dental
Other providers in Clinton, IN
- Union Hospital Inc
- Union Hospital Incorporated
- Union Hospital, Inc.
- Union Hospital, Inc.
- Vall Professionals Health Center
- Valley Professionals Community Health Center, Inc.
- Vermillion County Health Department
- Vermillion County Health Department
- Debra A Vincent
- Paul Alan Volstorf
All providers in Clinton, IN · Federally Qualified Health Center (FQHC) in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.