Healthcare Provider Details

I. General information

NPI: 1205105491
Provider Name (Legal Business Name): THE CENTER FOR RURAL HEALTH INNOVATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 LOCUST ST STE 204
SPRUCE PINE NC
28777-2702
US

IV. Provider business mailing address

167 LOCUST ST STE 204
SPRUCE PINE NC
28777-2702
US

V. Phone/Fax

Practice location:
  • Phone: 828-467-8815
  • Fax: 828-367-7827
Mailing address:
  • Phone: 828-467-8815
  • Fax: 828-367-7827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number235013
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number235013
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number235013
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA NORTH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 828-284-1541