MEDICARE: COMMUNITY HEALTH CENTER, INC.

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1619645769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	110 S WOODLAND ST
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3546
Country	:	US
Telephone Number	:	407-905-8827
Fax Number	:	407-905-8998

Provider Business Practice Location Address
First Line	:	600 S DOLLINS AVE STE 100-A
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32805-3009
Country	:	US
Telephone Number	:	407-905-8827
Fax Number	:

Authorized Official
Title or Position	:	MANAGED CARE COORDINATOR
Name	:	EUNICE Y CLARKE
Credential	:
Telephone Number	:	407-905-8827

Provider Enumeration Date	:	09/02/2021
Last Update Date	:	09/02/2021

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