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General NPI Number Information
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NPI Number | 1912996067
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Entity Type | Organization
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Legal Business Name | PUTNAM COUNTY RURAL HEALTH CLINIC, INC
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 117 W COMMERCIAL AVE
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City | MONTEREY
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State | TN
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Zip | 38574-1107
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Country | US
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Telephone | 931-839-6695
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Fax | 931-839-7023
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Provider Business Mailing Address
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Address Line | PO BOX 175
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City | BAXTER
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State | TN
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Zip | 38544-0175
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Country | US
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Telephone | 931-858-2116
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Fax | 931-858-2117
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JANE KISSANE
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Credential |
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Telephone | 931-858-2116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | TN
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