Provider Demographics
NPI:1114982360
Name:COMMUNITY HOSPITAL, INC
Entity Type:Organization
Organization Name:COMMUNITY HOSPITAL, INC
Other - Org Name:TALLASSEE FAMILY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BELLEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-286-3477
Mailing Address - Street 1:115 HERREN HILL RD
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-1276
Mailing Address - Country:US
Mailing Address - Phone:334-283-3477
Mailing Address - Fax:
Practice Address - Street 1:115 HERREN HILL RD
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-1276
Practice Address - Country:US
Practice Address - Phone:334-283-3477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I074Medicare PIN