Provider Demographics
NPI:1285927038
Name:COMMUNITY CLINIC, INC.
Entity type:Organization
Organization Name:COMMUNITY CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-924-3017
Mailing Address - Street 1:3737 N MERIDIAN ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4348
Mailing Address - Country:US
Mailing Address - Phone:317-924-3017
Mailing Address - Fax:317-926-1435
Practice Address - Street 1:3737 N MERIDIAN ST
Practice Address - Street 2:SUITE 402
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4348
Practice Address - Country:US
Practice Address - Phone:317-924-3017
Practice Address - Fax:317-926-1435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care