Healthcare Provider Details

I. General information

NPI: 1255461265
Provider Name (Legal Business Name): RURAL HEALTHCARE DEVELOPERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2533 MAIN ST
PLANTERSVILLE MS
38862-7907
US

IV. Provider business mailing address

2533 MAIN ST PO BOX 489
PLANTERSVILLE MS
38862-7907
US

V. Phone/Fax

Practice location:
  • Phone: 662-840-0196
  • Fax: 662-840-0198
Mailing address:
  • Phone: 662-840-0196
  • Fax: 662-840-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number07341/11.1
License Number StateMS

VIII. Authorized Official

Name: MR. ELSTON C KEMP
Title or Position: CEO
Credential:
Phone: 662-840-0196