Provider Demographics
NPI:1790787919
Name:COMMUNITY HEALTH CENTER OF BUFFALO, INC.
Entity type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF BUFFALO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMIQUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-986-9199
Mailing Address - Street 1:34 BENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1761
Mailing Address - Country:US
Mailing Address - Phone:716-986-9199
Mailing Address - Fax:716-835-9353
Practice Address - Street 1:34 BENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1761
Practice Address - Country:US
Practice Address - Phone:716-986-9199
Practice Address - Fax:716-835-9354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1401230R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02045283Medicaid
NY02045283Medicaid
NY331892Medicare Oscar/Certification
NY331011Medicare Oscar/Certification