Provider Demographics
NPI:1821440629
Name:CENTER STREET COMMUNITY CLINIC INC
Entity Type:Organization
Organization Name:CENTER STREET COMMUNITY CLINIC INC
Other - Org Name:MORROW FAMILY HEALTH CENTER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINS
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:740-751-4531
Mailing Address - Street 1:9 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1212
Mailing Address - Country:US
Mailing Address - Phone:419-946-3856
Mailing Address - Fax:
Practice Address - Street 1:136 W CENTER ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-3704
Practice Address - Country:US
Practice Address - Phone:740-751-4189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)