Provider Demographics
NPI:1245417435
Name:COMMUNITY HEALTH CARE SYSTEMS, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CARE SYSTEMS, INC.
Other - Org Name:TRICOUNTY HEALTH SYSTEM-SPARTA
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 1:675 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:GA
Practice Address - Zip Code:31087-1837
Practice Address - Country:US
Practice Address - Phone:706-444-5241
Practice Address - Fax:478-864-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAO8BDFLSOtherMEDICARE FFS
GAE82459Medicare UPIN
GA511I080491OtherMEDICARE PART B
GA111811Medicare Oscar/Certification
GAH37060Medicare PIN
GA000467519AOtherMEDICAID FQHC
000060387SOtherMEDICAID FFS
GA511I080490OtherMEDICARE PART B
GAA96807Medicare PIN
GAGRP1619OtherMEDICARE FFS