Provider Demographics
NPI:1992918197
Name:RURAL HEALTH MEDICAL PROGRAM, INC.
Entity type:Organization
Organization Name:RURAL HEALTH MEDICAL PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HIM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-874-7428
Mailing Address - Street 1:PO BOX 2213
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-2213
Mailing Address - Country:US
Mailing Address - Phone:334-874-7428
Mailing Address - Fax:
Practice Address - Street 1:101 PARK PL
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6764
Practice Address - Country:US
Practice Address - Phone:334-874-7428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630000008Medicaid
AL630000008Medicaid