Healthcare Provider Details

I. General information

NPI: 1437574613
Provider Name (Legal Business Name): RURAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 PRINCE ROYAL DR SUITE A
BEREA KY
40403-1471
US

IV. Provider business mailing address

245 PRINCE ROYAL DR SUITE A
BEREA KY
40403-1471
US

V. Phone/Fax

Practice location:
  • Phone: 859-582-7663
  • Fax: 859-335-1560
Mailing address:
  • Phone: 859-582-7663
  • Fax: 859-335-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number32006
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1103
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3008382
License Number StateKY

VIII. Authorized Official

Name: FADI BACHA
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 859-312-9674