=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841513058
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRIST COMMUNITY HEALTH SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2010
-----------------------------------------------------
Last Update Date | 05/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5366 MENDENHALL MALL
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38115-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-271-6100
-----------------------------------------------------
Fax | 901-271-6199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2670 UNION AVENUE EXT STE 1000
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38112-4416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-260-8551
-----------------------------------------------------
Fax | 901-260-8590
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. TRACY MCDANIEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-842-3160
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------