Provider Demographics
NPI:1548414055
Name:COMMUNITY HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH SYSTEMS, INC.
Other - Org Name:FALLBROOK INTERNAL AND PULMONARY MEDICINE
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 1:1328 S MISSION RD
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-4006
Mailing Address - Country:US
Mailing Address - Phone:760-451-4790
Mailing Address - Fax:760-451-4795
Practice Address - Street 1:22675 ALESSANDRO BLVD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-8551
Practice Address - Country:US
Practice Address - Phone:951-571-2300
Practice Address - Fax:951-571-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
CAC36017207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982756086Medicaid
CA4998231Medicaid
CAPTANCK277BOtherMEDICARE
CAHAP70275GOtherFAMILY PACT
CA70275GOtherBCP
CAEAP70324FOtherEAPC
CAPTANCK277BOtherMEDICARE