| NPI | 1295294890 |
|---|---|
| Doing Business As | INDIAN LAKE COMMUNITY HEALTH CENTER |
| Entity Type | Organization |
| Authorized Contact | ANDREW HERSHBERGER CFO 937-599-1411 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-03-14 |
| Last Update Date | 2019-03-14 |