Provider Demographics
NPI:1417998287
Name:RURAL HEALTH SOLUTIONS PA
Entity type:Organization
Organization Name:RURAL HEALTH SOLUTIONS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:361-387-9233
Mailing Address - Street 1:PO BOX 10426
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78460-0426
Mailing Address - Country:US
Mailing Address - Phone:361-387-9233
Mailing Address - Fax:361-387-8992
Practice Address - Street 1:327 W AVE J
Practice Address - Street 2:
Practice Address - City:ROBSTOWN
Practice Address - State:TX
Practice Address - Zip Code:78380-2207
Practice Address - Country:US
Practice Address - Phone:361-387-9233
Practice Address - Fax:361-387-8992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
TXJ2176261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161231901Medicaid
TX137311013Medicaid
TX161231902Medicaid
TX161231901Medicaid
TX161231902Medicaid