Provider Demographics
NPI:1669524534
Name:COMMUNITY HEALTH SYSTEMS INC
Entity type:Organization
Organization Name:COMMUNITY HEALTH SYSTEMS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-571-2300
Mailing Address - Street 1:22675 ALESSANDRO BLVD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-8551
Mailing Address - Country:US
Mailing Address - Phone:951-571-2300
Mailing Address - Fax:951-571-2330
Practice Address - Street 1:1744 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-5364
Practice Address - Country:US
Practice Address - Phone:951-224-8220
Practice Address - Fax:951-224-8230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47987122300000X
CA40093122300000X
CA27343122300000X
CA58321122300000X
CA409961223G0001X
CA407341223G0001X
CA468941223P0221X
CAA50693207Q00000X
CAA86874207Q00000X
CA11901207Q00000X
CA15571207Q00000X
CA11428207Q00000X
CA250000756261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669524534Medicaid
CAEAP70324FMedicaid
CAEAP70324FMedicaid
CA1669524534Medicaid