Provider Demographics
NPI:1215471032
Name:RURAL HEALTH MEDICAL PROGRAM, INC
Entity type:Organization
Organization Name:RURAL HEALTH MEDICAL PROGRAM, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-874-7428
Mailing Address - Street 1:111 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:AL
Mailing Address - Zip Code:36783-0276
Mailing Address - Country:US
Mailing Address - Phone:334-627-3497
Mailing Address - Fax:
Practice Address - Street 1:111 MAIN STREET
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:AL
Practice Address - Zip Code:36783-0276
Practice Address - Country:US
Practice Address - Phone:334-627-3497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RURAL HEALTH MEDICAL PROGRAMS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-13
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)