Healthcare Provider Details

I. General information

NPI: 1063996973
Provider Name (Legal Business Name): RURAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 N MAIN ST
ANNA IL
62906-1668
US

IV. Provider business mailing address

513 N MAIN ST
ANNA IL
62906-1668
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-4471
  • Fax: 618-833-4900
Mailing address:
  • Phone: 618-833-4471
  • Fax: 618-833-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: CINDY K FLAMM
Title or Position: CEO
Credential: LCSW
Phone: 618-833-4471