Healthcare Provider Details

I. General information

NPI: 1669524534
Provider Name (Legal Business Name): COMMUNITY HEALTH SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 UNIVERSITY AVE
RIVERSIDE CA
92507-5364
US

IV. Provider business mailing address

22675 ALESSANDRO BLVD
MORENO VALLEY CA
92553-8551
US

V. Phone/Fax

Practice location:
  • Phone: 951-224-8220
  • Fax: 951-224-8230
Mailing address:
  • Phone: 951-571-2300
  • Fax: 951-571-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number47987
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number40093
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number27343
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number58321
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number40996
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number40734
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number46894
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA50693
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA86874
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11901
License Number StateCA
# 11
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15571
License Number StateCA
# 12
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11428
License Number StateCA
# 13
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number250000756
License Number StateCA

VIII. Authorized Official

Name: JACK E JOHNS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 951-571-2300