Basic Information
| Provider Information | |||||||||
| NPI: | 1790116218 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY ACTION COMMITTEE OF PIKE COUNTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 941 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | PIKETON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456619757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402892371 | ||||||||
| FaxNumber: | 7402893545 | ||||||||
| Practice Location | |||||||||
| Address1: | 621 BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456624788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409614011 | ||||||||
| FaxNumber: | 7409614010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2013 | ||||||||
| LastUpdateDate: | 06/09/2020 | ||||||||
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| AuthorizedOfficialLastName: | PITTS | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
| AuthorizedOfficialMiddleName: | ERIC | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7402892371 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/09/2020 | ||||||||
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 | 0098336 | 05 | OH | MEDICAID |