Provider Demographics
NPI:1194276832
Name:WALNUT STREET COMMUNITY HEALTH CENTER INC.
Entity type:Organization
Organization Name:WALNUT STREET COMMUNITY HEALTH CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-745-3777
Mailing Address - Street 1:201 SOUTH CLEVELAND AVE.
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740
Mailing Address - Country:US
Mailing Address - Phone:301-745-3777
Mailing Address - Fax:301-393-3459
Practice Address - Street 1:201 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5745
Practice Address - Country:US
Practice Address - Phone:301-745-3777
Practice Address - Fax:301-393-3459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental