Provider Demographics
NPI:1114478823
Name:COMMUNITY HEALTH SERVICE INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CMO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-236-6502
Mailing Address - Street 1:2310 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2473
Mailing Address - Country:US
Mailing Address - Phone:218-236-6502
Mailing Address - Fax:218-236-6507
Practice Address - Street 1:1113 W 11TH ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-2139
Practice Address - Country:US
Practice Address - Phone:701-352-4048
Practice Address - Fax:701-352-0268
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH SERVICE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-18
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)