Provider Demographics
NPI:1851718712
Name:COMMUNITY HEALTH CLINIC PLLC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-693-0030
Mailing Address - Street 1:80 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3564
Mailing Address - Country:US
Mailing Address - Phone:413-693-0030
Mailing Address - Fax:413-731-1476
Practice Address - Street 1:80 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3564
Practice Address - Country:US
Practice Address - Phone:413-693-0030
Practice Address - Fax:413-731-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53138261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care