MEDICARE: RURAL HEALTH, INC.

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	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9115001	OTHER	IL	BLUE CROSS BLUE SHIELD
2	111760	OTHER	IL	HEALTHLINK
3	055761	OTHER	IL	HEALTH ALLIANCE

General Provider Information

NPI Number	:	1366506628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RURAL HEALTH, INC.

Provider Business Mailing Address
First Line	:	513 N MAIN ST
Second Line	:
City	:	ANNA
State	:	IL
Zip	:	62906-1668
Country	:	US
Telephone Number	:	618-833-4471
Fax Number	:	618-833-8878

Provider Business Practice Location Address
First Line	:	318 N US HIGHWAY 51
Second Line	:
City	:	DONGOLA
State	:	IL
Zip	:	62926
Country	:	US
Telephone Number	:	618-827-3545
Fax Number	:	618-827-4891

Authorized Official
Title or Position	:	C. E. O.
Name	:	MS. CYNTHIA K FLAMM
Credential	:	LCSW
Telephone Number	:	618-833-4471

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	09/05/2018

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Directions to “RURAL HEALTH, INC. ” Practice Location

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