Provider Demographics
NPI:1235498122
Name:WALNUT STREET COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:WALNUT STREET COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MURDAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-745-3777
Mailing Address - Street 1:201 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5745
Mailing Address - Country:US
Mailing Address - Phone:301-745-3777
Mailing Address - Fax:301-733-5731
Practice Address - Street 1:328 N POTOMAC ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-3820
Practice Address - Country:US
Practice Address - Phone:301-745-3777
Practice Address - Fax:301-733-5731
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1366425266
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-11
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)