NPIMap

Organization Active NPI

Center Street Community Clinic Inc

Doing business as Galion Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Galion, OH
National Provider Identifier
1942840871
Registry record updated Jan 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTER STREET COMMUNITY CLINIC INC
Doing business as
Galion Family Health Center
Practice address
126 Harding Way E
Galion, OH 44833-1901
Phone
(740) 751-6380
NPI assigned
Jan 8, 2020
Last updated
Jan 8, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTER STREET COMMUNITY CLINIC INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 8, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Audrey Cobb
Title
Cfo
Phone
(740) 751-4531

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

126 Harding Way E
Galion, OH 44833-1901

Mailing address

136 W Center St
Marion, OH 43302-3704
Phone (740) 751-4531

Other names 1

  • Galion Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200807001502 OH Part A Provider - Federally Qualified Health Center (FQHC) 7012815210 Practice locations: Galion, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942840871. Details of each certification follow.

Federally qualified health center certification: CCN 721858

Legal name
CENTER STREET COMMUNITY CLINIC INC
Doing business as
GALION FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 29, 2020
Last certification
Jul 29, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 30, 1993 in OH
Enrollment address
126 Harding Way E
Galion, OH 44833-1901

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Ctr St Community Clinic9 organizations share this tax ID, including this one
Part of
Ctr St Community Clinic

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

136 W Center St
Marion, OH 43302
Phone (740) 751-4531

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Clifton Edwards Individual Corporate OfficerCeo Jul 1, 2020 100%
W-2 Managing EmployeeCeo Jul 1, 2020 100%
Audrey Adkins Individual Corporate OfficerCfo Jul 1, 2020 100%
W-2 Managing EmployeeCfo Jul 1, 2020 100%
Sylvia Reineke Individual Corporate DirectorBoard Member Jul 1, 2020 100%
Karen Ream Individual Corporate DirectorBoard Member Jul 1, 2020 100%

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578441600000",
    "number": "1942840871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 W CENTER ST",
            "city": "MARION",
            "state": "OH",
            "postal_code": "433023704",
            "telephone_number": "740-751-4531",
            "fax_number": "740-751-4866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 HARDING WAY E",
            "city": "GALION",
            "state": "OH",
            "postal_code": "448331901",
            "telephone_number": "740-751-6380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER STREET COMMUNITY CLINIC INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTER STREET COMMUNITY CLINIC INC",
        "enumeration_date": "2020-01-08",
        "last_updated": "2020-01-08",
        "certification_date": "2020-01-08",
        "status": "A",
        "authorized_official_last_name": "COBB",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "740-751-4531"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Galion Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Galion, OH

Sources for this page

Verify at the official NPI Registry.