Healthcare Provider Details

I. General information

NPI: 1528041191
Provider Name (Legal Business Name): COMMUNITY HEALTH SERVICE AGENCY,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 WESLEY ST
GREENVILLE TX
75401-5639
US

IV. Provider business mailing address

PO BOX 1908
GREENVILLE TX
75403-1908
US

V. Phone/Fax

Practice location:
  • Phone: 903-455-5958
  • Fax: 903-454-4514
Mailing address:
  • Phone: 903-455-5986
  • Fax: 903-454-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE P CARTER
Title or Position: CEO
Credential:
Phone: 903-455-5986