Provider Demographics
NPI:1245400969
Name:COMMUNITY HEALTH CARE SYSTEMS, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CARE SYSTEMS, INC.
Other - Org Name:TRICOUNTY HEALTH SYSTEMS-GIBSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:W
Authorized Official - Last Name:BELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-552-7384
Mailing Address - Street 1:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31096-0371
Mailing Address - Country:US
Mailing Address - Phone:478-864-3448
Mailing Address - Fax:478-864-1288
Practice Address - Street 1:702 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:GIBSON
Practice Address - State:GA
Practice Address - Zip Code:30810-4135
Practice Address - Country:US
Practice Address - Phone:706-598-3359
Practice Address - Fax:706-598-3403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
111003Medicare Oscar/Certification
GA08BDMNGOtherMEDICARE FFS
GA10057319OtherAMERIGROUP MCAID
GAGRP1619OtherMEDICARE FFS
GA000060387ROtherMEDICAID FFS
GA000302068IOtherMEDICAID FFS
GA000308228DOtherMEDICAID FFS
GA10057285OtherAMERIGROUP MCAID
GA10060509OtherAMERIGROUP MCAID
GAE82459Medicare UPIN
GA000471809BOtherMEDICAID FQHC
GA08BBWTQOtherMEDICARE FFS
GA341628OtherWELLCARE MCAID
GAD46411Medicare UPIN
GAI33394Medicare UPIN
GA111812Medicare Oscar/Certification
GA08BDFLSOtherMEDICARE FFS
GAD46114Medicare UPIN
GA980939645EOtherMEDICAID FFS