Healthcare Provider Details

I. General information

NPI: 1912996067
Provider Name (Legal Business Name): PUTNAM COUNTY RURAL HEALTH CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W COMMERCIAL AVE
MONTEREY TN
38574-1107
US

IV. Provider business mailing address

PO BOX 175
BAXTER TN
38544-0175
US

V. Phone/Fax

Practice location:
  • Phone: 931-839-6695
  • Fax: 931-839-7023
Mailing address:
  • Phone: 931-858-2116
  • Fax: 931-858-2117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateTN

VIII. Authorized Official

Name: MS. JANE KISSANE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 931-858-2116