1700045820 NPI number — RURAL HEALTH GROUP, INC.

Table of content: (NPI 1700045820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700045820 NPI number — RURAL HEALTH GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RURAL HEALTH GROUP, 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:
RURAL HEALTH GROUP AT NORLINA
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:
1700045820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 640
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE RAPIDS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27870-0640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-536-5440
Provider Business Mailing Address Fax Number:
252-536-5444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 DIVISION STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORLINA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27563-0149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-456-2009
Provider Business Practice Location Address Fax Number:
252-456-2889
Provider Enumeration Date:
06/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
O.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
252-536-5871

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: 02153 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 344002A/C , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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