MEDICARE: COMMUNITY HEALTH CLINIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134694771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH CLINIC, INC.

Provider Business Mailing Address
First Line	:	943 FOURTH AVE
Second Line	:
City	:	NEW KENSINGTON
State	:	PA
Zip	:	15068-6409
Country	:	US
Telephone Number	:	724-335-3334
Fax Number	:	724-335-2283

Provider Business Practice Location Address
First Line	:	181 COLUMBIA AVE
Second Line	:
City	:	VANDERGRIFT
State	:	PA
Zip	:	15690-1203
Country	:	US
Telephone Number	:	724-335-3334
Fax Number	:	724-335-2283

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BRENDA BOWMAN
Credential	:
Telephone Number	:	724-335-3334

Provider Enumeration Date	:	10/10/2018
Last Update Date	:	10/10/2018

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