MEDICARE: RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	3703869	OTHER		CIGNA/MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	029856300	OTHER		BLACKLUNG
2	007	OTHER		CHAMPUS PROVIDER
3	4122525	OTHER	TN	BLUECROSS BLUESHELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013917632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC

Provider Business Mailing Address
First Line	:	PO BOX 850
Second Line	:
City	:	ROGERSVILLE
State	:	TN
Zip	:	37857-0850
Country	:	US
Telephone Number	:	423-272-9163
Fax Number	:	423-921-6920

Provider Business Practice Location Address
First Line	:	4966 HIGHWAY 11W
Second Line	:
City	:	ROGERSVILLE
State	:	TN
Zip	:	37857-6028
Country	:	US
Telephone Number	:	423-272-5600
Fax Number	:	423-272-1428

Authorized Official
Title or Position	:	CEO
Name	:	MRS. LINDA W BUCK
Credential	:
Telephone Number	:	423-272-9163

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	10/10/2008

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