Provider Demographics
NPI:1821475575
Name:COMMUNITY HEALTH SERVICE AGENCY, INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH SERVICE AGENCY, INC
Other - Org Name:PEDIATRIC CENTER OF GREENVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-455-5986
Mailing Address - Street 1:PO BOX 1908
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-1908
Mailing Address - Country:US
Mailing Address - Phone:903-454-3025
Mailing Address - Fax:903-450-1408
Practice Address - Street 1:3005 JOE RAMSEY BLVD E STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7776
Practice Address - Country:US
Practice Address - Phone:903-455-4458
Practice Address - Fax:903-455-1604
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH SERVICE AGENCY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-01
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX368577801Medicaid