Organization
CENTER STREET COMMUNITY CLINIC INC
Active
Other names
Center Street Community Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CLIFF G EDWARDS (CEO/EXECUTIVE DIRECTOR)
(740) 751-6380
Entity
Organization
Contact information
Practice address
205 W CENTER ST, SUITE 200, MARION, OH 43302-3700
(740) 751-4189
(740) 751-4866
Mailing address
205 W CENTER ST, SUITE 200, MARION, OH 43302-3700
(740) 751-4189
(740) 751-4866
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2859509
—
OH
Enumeration date
05/08/2008
Last updated
01/21/2015
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