Provider Demographics
NPI:1376535278
Name:COMMUNITY HEALTH CARE SYSTEMS,INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CARE SYSTEMS,INC.
Other - Org Name:TRICOUNTY HEALTH SYSTEM-WARRENTON
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 2:2251 WEST ELM STREET
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 1:1008 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:GA
Practice Address - Zip Code:30828-0312
Practice Address - Country:US
Practice Address - Phone:706-465-3253
Practice Address - Fax:478-864-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
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
GA08BBWTQOtherMEDICARE FFS
GA613634OtherGA STATE HEALTH #
GA000308228BMedicaid
GA980939645CMedicaid
GA10057255OtherAMERIGROUP MCAID
GA10057307OtherAMERIGROUP MCAID
GA342410OtherWELLCARE
GA000302068GMedicaid
GA10060509OtherAMERIGROUP MCAID
GA08BDFZDOtherMEDICARE FFS
GA111814Medicare Oscar/Certification
080150840OtherMED.RR RETIRED PALMETTO
GA08BBSCLOtherMEDICARE FFS
GA000471809AMedicaid
080150839OtherMED.RR RETIRED PALMETTO
11SCCWTOtherMEDICARE FFS
GA755634OtherGA STATE HEALTH #
08BDMNGOtherMEDICARE FFS
GA680733OtherGA STATE HEALTH #
GRP1619OtherMEDICARE FFS
P00015170OtherMED.RR RETIRED PALMETTO
GA000471809CMedicaid
GA000788081BMedicaid