Healthcare Provider Details

I. General information

NPI: 1376044552
Provider Name (Legal Business Name): RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BOONES CREEK RD
JONESBOROUGH TN
37659
US

IV. Provider business mailing address

PO BOX 850
ROGERSVILLE TN
37857-0850
US

V. Phone/Fax

Practice location:
  • Phone: 423-788-9374
  • Fax: 423-788-9377
Mailing address:
  • Phone: 423-272-9163
  • Fax: 423-921-6920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LINDA W BUCK
Title or Position: PRESIDENT/CEO
Credential:
Phone: 423-272-9163