Provider Demographics
NPI:1952562696
Name:CHRIST COMMUNITY HEALTH SERVICES INC
Entity Type:Organization
Organization Name:CHRIST COMMUNITY HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BURT
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-260-8551
Mailing Address - Street 1:2595 CENTRAL AVE
Mailing Address - Street 2:CHRIST COMMUNITY HEALTH SERVICES,INC
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5905
Mailing Address - Country:US
Mailing Address - Phone:901-260-8551
Mailing Address - Fax:901-260-8590
Practice Address - Street 1:2861 BROAD AVENUE
Practice Address - Street 2:CHRIST COMMUNITY HEALTH SERVICES,INC
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112
Practice Address - Country:US
Practice Address - Phone:901-260-8450
Practice Address - Fax:901-325-6469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3707256OtherMEDICAID GROUP NUMBER
TN3707256OtherMEDICARE GROUP NUMBER
TN441874Medicare Oscar/Certification