Provider Demographics
NPI:1497206197
Name:COMMUNITY HEALTH SERVICE INC.
Entity type:Organization
Organization Name:COMMUNITY HEALTH SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ASIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-422-7424
Mailing Address - Street 1:810 4TH AVE S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2800
Mailing Address - Country:US
Mailing Address - Phone:218-236-6502
Mailing Address - Fax:218-236-6507
Practice Address - Street 1:1804 TROTT AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-2743
Practice Address - Country:US
Practice Address - Phone:320-214-7286
Practice Address - Fax:320-214-7223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH SERVICE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)