Healthcare Provider Details

I. General information

NPI: 1982156139
Provider Name (Legal Business Name): RURALBASICSHC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MAIN ST W
WABASHA MN
55981-1236
US

IV. Provider business mailing address

131 MAIN ST W
WABASHA MN
55981-1236
US

V. Phone/Fax

Practice location:
  • Phone: 507-884-0651
  • Fax: 651-565-4863
Mailing address:
  • Phone: 507-884-0651
  • Fax: 651-565-4863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS DENAY LYNN KELLY
Title or Position: PRESIDENT
Credential: ARNP
Phone: 507-884-0651