MEDICARE: COMMUNITY AND RURAL HEALTH SERVICES

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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1437321239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY AND RURAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	410 BIRCHARD AVE
Second Line	:
City	:	FREMONT
State	:	OH
Zip	:	43420-2967
Country	:	US
Telephone Number	:	419-334-8943
Fax Number	:	419-334-8619

Provider Business Practice Location Address
First Line	:	418 BIRCHARD AVE
Second Line	:
City	:	FREMONT
State	:	OH
Zip	:	43420-2967
Country	:	US
Telephone Number	:	419-334-8943
Fax Number	:	419-334-8619

Authorized Official
Title or Position	:	DIRECTOR OF HUMAN RESOURCES
Name	:	MS. TIFFANY SEDLAR
Credential	:
Telephone Number	:	419-334-8943

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	07/09/2012

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Directions to “COMMUNITY AND RURAL HEALTH SERVICES ” Practice Location

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