1114919685 NPI number — COMMUNITY HEALTH & EMERGENCY SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114919685 NPI number — COMMUNITY HEALTH & EMERGENCY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH & EMERGENCY SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TAMMS HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114919685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3008
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARBONDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62902-3008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-457-0450
Provider Business Mailing Address Fax Number:
618-457-7329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 SECOND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMMS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-747-2391
Provider Business Practice Location Address Fax Number:
618-747-2371
Provider Enumeration Date:
08/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BERNSTEIN
Authorized Official First Name:
FREDERICK
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
618-457-0450

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1616948 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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