Healthcare Provider Details

I. General information

NPI: 1871234294
Provider Name (Legal Business Name): WALNUT STREET COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S CLEVELAND AVE SUITE 101
HAGERSTOWN MD
21740-5758
US

IV. Provider business mailing address

201 S CLEVELAND AVE STE 101
HAGERSTOWN MD
21740-5758
US

V. Phone/Fax

Practice location:
  • Phone: 301-745-3777
  • Fax: 301-393-3476
Mailing address:
  • Phone: 301-745-3777
  • Fax: 301-393-3476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY Z MURDAUGH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 301-745-3777