Provider Demographics
NPI:1467692392
Name:COMMUNITY HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH SYSTEMS, INC.
Other - Org Name:FALLBROOK WOMEN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-571-2300
Mailing Address - Street 1:22675 ALESSANDRO BLVD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-8551
Mailing Address - Country:US
Mailing Address - Phone:951-571-2300
Mailing Address - Fax:951-571-2330
Practice Address - Street 1:1328 S MISSION RD
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-4006
Practice Address - Country:US
Practice Address - Phone:760-451-4730
Practice Address - Fax:760-451-4700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-05
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000150207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982756086Medicaid
CABCP70275GMedicaid
CAEAP70324FMedicaid
CAHAP70275GMedicaid
CA4998231Medicaid
CA1982756086Medicaid