=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255461265
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RURAL HEALTHCARE DEVELOPERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 05/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2533 MAIN ST
-----------------------------------------------------
City | PLANTERSVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38862-7907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-840-0196
-----------------------------------------------------
Fax | 662-840-0198
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2533 MAIN ST PO BOX 489
-----------------------------------------------------
City | PLANTERSVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38862-7907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-840-0196
-----------------------------------------------------
Fax | 662-840-0198
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. ELSTON C KEMP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-840-0196
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 07341/11.1
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------