Provider Demographics
NPI:1194990101
Name:DR. RUANTO'S CLINIC
Entity type:Organization
Organization Name:DR. RUANTO'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:N
Authorized Official - Last Name:RUANTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-243-4176
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:104 OLD JEFFERSON STREET
Mailing Address - City:CELINA
Mailing Address - State:TN
Mailing Address - Zip Code:38551-0347
Mailing Address - Country:US
Mailing Address - Phone:931-243-4176
Mailing Address - Fax:931-243-4641
Practice Address - Street 1:104 OLD JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TN
Practice Address - Zip Code:38551-0347
Practice Address - Country:US
Practice Address - Phone:931-243-4176
Practice Address - Fax:931-243-4641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13102261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3183603Medicaid
TNB59443Medicare UPIN