=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639947286
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RURAL HEALTH CLINICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2023
-----------------------------------------------------
Last Update Date | 12/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1369A GEORGE WALLACE HWY
-----------------------------------------------------
City | RUSSELLVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35654-3281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-333-4118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1369A GEORGE WALLACE HWY
-----------------------------------------------------
City | RUSSELLVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35654-3281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-503-3081
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MEMBER
-----------------------------------------------------
Name | KEVIN P BOWLING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 256-333-4118
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------