1154321966 NPI number — RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC

Table of content: (NPI 1154321966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154321966 NPI number — RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WEST MAIN MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154321966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 850
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROGERSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37857-0850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-272-9163
Provider Business Mailing Address Fax Number:
423-921-6920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROGERSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37857-2448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-272-5202
Provider Business Practice Location Address Fax Number:
423-272-4696
Provider Enumeration Date:
07/22/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BUCK
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
423-272-9163

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4448314 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 031 . This is a "CHAMPUS PROVIDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3716673 . This is a "CIGNA/MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4122525 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 020366000 . This is a "BLACKLUNG" identifier . This identifiers is of the category "OTHER".