Provider Demographics
NPI:1134694771
Name:COMMUNITY HEALTH CLINIC, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-335-3334
Mailing Address - Street 1:943 FOURTH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-6409
Mailing Address - Country:US
Mailing Address - Phone:724-335-3334
Mailing Address - Fax:724-335-2283
Practice Address - Street 1:181 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:VANDERGRIFT
Practice Address - State:PA
Practice Address - Zip Code:15690-1203
Practice Address - Country:US
Practice Address - Phone:724-335-3334
Practice Address - Fax:724-335-2283
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101267643Medicaid