Provider Demographics
NPI:1871844167
Name:COMMUNITY HEALTH SERVICE AGENCY,INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH SERVICE AGENCY,INC
Other - Org Name:CHSA DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICIER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:903-455-5986
Mailing Address - Street 1:4500 WESLEY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-5644
Mailing Address - Country:US
Mailing Address - Phone:903-454-3025
Mailing Address - Fax:903-450-1408
Practice Address - Street 1:3600 CADDO ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-4511
Practice Address - Country:US
Practice Address - Phone:903-454-6965
Practice Address - Fax:903-454-7981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty