Provider Demographics
NPI:1124269022
Name:RURAL HEALTH GROUP, INC.
Entity type:Organization
Organization Name:RURAL HEALTH GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-536-5871
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0640
Mailing Address - Country:US
Mailing Address - Phone:252-536-5791
Mailing Address - Fax:252-536-5444
Practice Address - Street 1:100 W PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5923
Practice Address - Country:US
Practice Address - Phone:252-536-5791
Practice Address - Fax:252-536-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC022H1OtherBCBS
NC344023A/CMedicaid
NC022H1OtherBCBS
NC341946Medicare PIN