Healthcare Provider Details

I. General information

NPI: 1568462372
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: 07/22/2005
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 HIGHWAY 143
ROAN MOUNTAIN TN
37687-3002
US

IV. Provider business mailing address

PO BOX 850
ROGERSVILLE TN
37857-0850
US

V. Phone/Fax

Practice location:
  • Phone: 423-772-3276
  • Fax: 423-772-4816
Mailing address:
  • Phone: 423-272-9163
  • Fax: 423-921-6920

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: MRS. LINDA W BUCK
Title or Position: CEO
Credential:
Phone: 423-272-9163