Basic Information
| Provider Information | |||||||||
| NPI: | 1114902137 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HEALTH CARE INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1193 NORTON AVE | ||||||||
| Address2: | STE. A | ||||||||
| City: | NORTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442039516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308251152 | ||||||||
| FaxNumber: | 3308259569 | ||||||||
| Practice Location | |||||||||
| Address1: | 944 CHERRY ST E | ||||||||
| Address2: | |||||||||
| City: | CANAL FULTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446148669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308544574 | ||||||||
| FaxNumber: | 3308540829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 09/02/2011 | ||||||||
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| AuthorizedOfficialLastName: | ISON | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
| AuthorizedOfficialMiddleName: | K. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO, PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3308544574 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | CF1366 | 01 | OH | MEDICARE RAILROAD GROUP | OTHER | 0642479 | 05 | OH | MEDICAID | 0827538 | 05 | OH | MEDICAID | 0842217 | 05 | OH | MEDICAID | 0683890 | 05 | OH | MEDICAID | 2167211 | 05 | OH | MEDICAID | CF0079 | 01 | OH | RAILROAD MEDICARE GROUP | OTHER | CK4119 | 01 | OH | RAILROAD MEDICARE GROUP | OTHER | 0683194 | 05 | OH | MEDICAID | 2267658 | 05 | OH | MEDICAID | 2717822 | 05 | OH | MEDICAID |