1235305954 NPI number — HARRY R. RUTH, M.D.,P.C.

Table of content: (NPI 1235305954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235305954 NPI number — HARRY R. RUTH, M.D.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARRY R. RUTH, M.D.,P.C.
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:
Provider Other Organization Name Type Code:
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:
1235305954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1107 COLLEGE AVE
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
QUINCY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62301-2664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-228-3377
Provider Business Mailing Address Fax Number:
217-228-2657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1107 COLLEGE AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62301-2664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-228-3377
Provider Business Practice Location Address Fax Number:
217-228-2657
Provider Enumeration Date:
05/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
OWENS
Authorized Official First Name:
MARCA
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
217-228-3377

Provider Taxonomy Codes

  • Taxonomy code: 207YX0602X , with the licence number:  036068434 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036068434 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202444915 . This is a "MEDICAID" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 243437 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00122928 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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