1891739223 NPI number — RURAL HEALTH SOLUTIONS PA

Table of content: (NPI 1891739223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891739223 NPI number — RURAL HEALTH SOLUTIONS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RURAL HEALTH SOLUTIONS PA
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:
6
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:
1891739223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10426
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78460-0426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-241-6700
Provider Business Mailing Address Fax Number:
361-241-4302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1210 GREGORY
Provider Second Line Business Practice Location Address:
SUITE # 2
Provider Business Practice Location Address City Name:
TAFT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78390-3045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-528-2595
Provider Business Practice Location Address Fax Number:
361-528-3452
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAIN
Authorized Official First Name:
ELLIS
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PHYSICIAN - OWNER
Authorized Official Telephone Number:
361-387-9233

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , with the licence number: J2176 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 161238401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137311014 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 161238402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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