Healthcare Provider Details

I. General information

NPI: 1093767535
Provider Name (Legal Business Name): RURAL HEALTH GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MOSBY AVE
LITTLETON NC
27850-9411
US

IV. Provider business mailing address

2064 HWY 125 P.O. BOX 640
ROANOKE RAPIDS NC
27870-0640
US

V. Phone/Fax

Practice location:
  • Phone: 252-586-5151
  • Fax: 252-586-2028
Mailing address:
  • Phone: 252-536-5791
  • Fax: 252-536-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. JUDY BELCH BEASLEY
Title or Position: CORPORATE COMPLIANCE OFFICER
Credential:
Phone: 252-536-5791