Provider Demographics
NPI:1568454130
Name:COMMUNITY HEALTH & EMERGENCY SERVICES, INC.
Entity type:Organization
Organization Name:COMMUNITY HEALTH & EMERGENCY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-457-0450
Mailing Address - Street 1:PO BOX 3008
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3008
Mailing Address - Country:US
Mailing Address - Phone:618-457-0450
Mailing Address - Fax:618-457-7329
Practice Address - Street 1:IL ROUTE 146 BLDG 2
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:IL
Practice Address - Zip Code:62931
Practice Address - Country:US
Practice Address - Phone:618-285-6191
Practice Address - Fax:618-285-6833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1616948OtherBLUE CROSS BLUE SHIELD
IL=========008Medicaid
IL208194Medicare PIN
IL1616948OtherBLUE CROSS BLUE SHIELD