Organization
COMMUNITY CLINIC, INC.
Active
Other names
CCI Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
SONYA J BRUTON (CEO)
(240) 839-5107
Entity
Organization
Contact information
Practice address
7474 GREENWAY CENTER DR STE 300, GREENBELT, MD 20770-3592
(240) 624-2278
(240) 624-2279
Mailing address
8665 GEORGIA AVE, SILVER SPRING, MD 20910-3405
(301) 340-7525
(301) 495-0318
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
053601
MEDICARE PIN
MD
05
—
130061000
—
MD
Enumeration date
02/28/2019
Last updated
11/09/2023
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