MEDICARE: RURAL HEALTH ACCESS CORPORATION

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)

General Provider Information

NPI Number	:	1073489985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RURAL HEALTH ACCESS CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 4013
Second Line	:
City	:	CHAPMANVILLE
State	:	WV
Zip	:	25508-4013
Country	:	US
Telephone Number	:	304-855-1200
Fax Number	:	304-855-1230

Provider Business Practice Location Address
First Line	:	83 HOSPITAL DR
Second Line	:
City	:	LOGAN
State	:	WV
Zip	:	25601-3451
Country	:	US
Telephone Number	:	304-831-1630
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRENT TOMBLIN
Credential	:
Telephone Number	:	304-855-1200

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	01/12/2026

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