Provider Demographics
NPI:1972772242
Name:THE RUTHERFORD MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:THE RUTHERFORD MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:731-665-7741
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:TN
Mailing Address - Zip Code:38369-0370
Mailing Address - Country:US
Mailing Address - Phone:731-665-7741
Mailing Address - Fax:731-665-7750
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:TN
Practice Address - Zip Code:38369-9711
Practice Address - Country:US
Practice Address - Phone:731-665-7741
Practice Address - Fax:731-665-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5442152Medicaid
TN39294552Medicare PIN