Healthcare Provider Details

I. General information

NPI: 1306755483
Provider Name (Legal Business Name): NORTH CAROLINA RURAL HEALTH CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 STANLY PKWY STE A
LOCUST NC
28097-7711
US

IV. Provider business mailing address

1643 NW 136TH AVENUE BUILDING H, SUITE 100
SUNRISE FL
33323-2857
US

V. Phone/Fax

Practice location:
  • Phone: 731-772-4199
  • Fax:
Mailing address:
  • Phone: 818-452-7073
  • Fax: 865-560-7110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAMES HORST
Title or Position: PRESIDENT
Credential: DO
Phone: 865-693-1000