Provider Demographics
NPI:1982686614
Name:CHRIST COMMUNITY HEALTH SERVICES INC
Entity Type:Organization
Organization Name:CHRIST COMMUNITY HEALTH SERVICES INC
Other - Org Name:CHRIST COMMUNITY HEALTH SVCS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MAKRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:901-260-8500
Mailing Address - Street 1:2595 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5905
Mailing Address - Country:US
Mailing Address - Phone:901-260-8500
Mailing Address - Fax:901-260-8598
Practice Address - Street 1:3362 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-2944
Practice Address - Country:US
Practice Address - Phone:901-271-6300
Practice Address - Fax:901-271-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QF0400X, 261QF0400X
3336C0002X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3707256Medicaid
4437845OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TN3707256Medicaid