MEDICARE: SOUTHERN RURAL HEALTH CARE CONSORTIUM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225049828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN RURAL HEALTH CARE CONSORTIUM

Provider Business Mailing Address
First Line	:	PO BOX 970
Second Line	:
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-0970
Country	:	US
Telephone Number	:	256-332-1631
Fax Number	:	256-332-4600

Provider Business Practice Location Address
First Line	:	508 SAINT CLAIR ST SE
Second Line	:
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-2720
Country	:	US
Telephone Number	:	256-332-1631
Fax Number	:	256-332-4600

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. KATHY HALL
Credential	:
Telephone Number	:	256-332-1631

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	10/24/2011

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