Basic Information
| Provider Information | |||||||||
| NPI: | 1003879248 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY ACTION COMMITTEE OF PIKE CO., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 941 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | PIKETON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456619757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402892371 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 941 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | PIKETON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456619757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402892371 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 01/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | ROBERTS | ||||||||
| AuthorizedOfficialFirstName: | RAY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7402892371 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 0899327 | 05 | OH | MEDICAID | 1003908930 | 01 | WEST PORTSMOUTH FAMILY HEALTH CENTER NPI # | OTHER | 0865612 | 05 | OH | MEDICAID | 1093044331 | 01 | PORTSMOUTH FAMILY HEALTH CENTER NPI # | OTHER | 0873783 | 05 | OH | MEDICAID | 0899336 | 05 | OH | MEDICAID | 0989935 | 05 | OH | MEDICAID | 1891887790 | 01 | WAVERLY FAMILY HEALTH CENTER NPI # | OTHER | 1912099839 | 01 | PIKETON FAMILY HEALTH CENTER NPI # | OTHER | 0829465 | 05 | OH | MEDICAID | 2081349 | 05 | OH | MEDICAID | 1023100955 | 01 | JACKSON FAMILY HEALTH CENTER NPI | OTHER | 0100134 | 05 | OH | MEDICAID |