MEDICARE: COMMUNITY HEALTH SERVICE AGENCY, 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	261QF0400X	Federally Qualified Health Center (FQHC)

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	:	1184275711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH SERVICE AGENCY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1908
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75403-1908
Country	:	US
Telephone Number	:	39-454-3025
Fax Number	:	903-450-1408

Provider Business Practice Location Address
First Line	:	106 MEDICAL CIR
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-2138
Country	:	US
Telephone Number	:	903-885-1730
Fax Number	:	903-885-0050

Authorized Official
Title or Position	:	CFO
Name	:	MICHELLE P CARTER
Credential	:
Telephone Number	:	903-455-5986

Provider Enumeration Date	:	09/25/2019
Last Update Date	:	03/04/2026

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