Provider Demographics
NPI:1053825513
Name:COMMUNITY MEDICINE FOUNDATION INC
Entity Type:Organization
Organization Name:COMMUNITY MEDICINE FOUNDATION INC
Other - Org Name:NORTH CENTRAL FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-325-7744
Mailing Address - Street 1:1131 SALUDA STREET
Mailing Address - Street 2:NORTH CENTRAL FAMILY MEDICAL CENTER
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730
Mailing Address - Country:US
Mailing Address - Phone:803-325-7744
Mailing Address - Fax:803-325-1117
Practice Address - Street 1:205 PIEDMONT BLVD. SUITE 100
Practice Address - Street 2:CATAWBA COMMUNITY MENTAL HEALTH SERVICES YORK ADULT SER
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732
Practice Address - Country:US
Practice Address - Phone:803-327-2012
Practice Address - Fax:803-325-7744
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY MEDICINE FOUNDATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC025Medicaid