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	261QF0400X	Federally Qualified Health Center (FQHC)
2	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1780683573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY AND RURAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	2221 HAYES AVE
Second Line	:
City	:	FREMONT
State	:	OH
Zip	:	43420-2632
Country	:	US
Telephone Number	:	419-334-8943
Fax Number	:	419-334-8546

Provider Business Practice Location Address
First Line	:	2221 HAYES AVE
Second Line	:
City	:	FREMONT
State	:	OH
Zip	:	43420-2632
Country	:	US
Telephone Number	:	419-334-8943
Fax Number	:	419-334-8546

Authorized Official
Title or Position	:	DIRECTOR OF HUMAN RESOURCE
Name	:	JESSICA GARZA
Credential	:
Telephone Number	:	419-334-8943

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	07/27/2021

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