Basic Information
| Provider Information | |||||||||
| NPI: | 1750632659 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HEALTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 ALBANY AVE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061202508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602499625 | ||||||||
| FaxNumber: | 8608081580 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 ALBANY AVE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061202508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602499625 | ||||||||
| FaxNumber: | 8608081580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2012 | ||||||||
| LastUpdateDate: | 06/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | MONTGOMERY | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
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| AuthorizedOfficialTitleorPosition: | INTERIM CEO | ||||||||
| AuthorizedOfficialTelephone: | 8602499625 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | 0676 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Dental | 207V00000X | 0676 | CT | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 261QF0400X | 0676 | CT | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.