MEDICARE: COMMUNITY AND RURAL HEALTH SERVICES, 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	261QP2300X	Primary Care Clinic/Center
2	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669681870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY AND RURAL HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	2221 HAYES AVE
Second Line	:
City	:	FREMONT
State	:	OH
Zip	:	43420-2632
Country	:	US
Telephone Number	:	419-334-8943
Fax Number	:	419-334-8619

Provider Business Practice Location Address
First Line	:	2221 HAYES AVE
Second Line	:
City	:	FREMONT
State	:	OH
Zip	:	43420-2632
Country	:	US
Telephone Number	:	419-334-8943
Fax Number	:	419-334-8619

Authorized Official
Title or Position	:	CEO
Name	:	JOSEPH LISZAK
Credential	:
Telephone Number	:	419-334-8943

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/22/2024

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