MEDICARE: RURAL HEALTH MEDICAL PROGRAM, 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)		AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	011914	OTHER	AL	MEDICARE ID - TYPE UNSPECIFIED

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	:	1437238151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RURAL HEALTH MEDICAL PROGRAM, INC.

Provider Business Mailing Address
First Line	:	P O BOX 2213
Second Line	:	228 SELMA AVENUE
City	:	SELMA
State	:	AL
Zip	:	36702-2213
Country	:	US
Telephone Number	:	334-874-4728
Fax Number	:	334-874-7435

Provider Business Practice Location Address
First Line	:	1310 WASHINGTON STREET
Second Line	:
City	:	MARION
State	:	AL
Zip	:	36756-3218
Country	:	US
Telephone Number	:	334-683-2073
Fax Number	:	334-683-2077

Authorized Official
Title or Position	:	CEO
Name	:	MS. PATRICIA GIBSON
Credential	:
Telephone Number	:	334-874-7428

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	12/21/2010

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Directions to “RURAL HEALTH MEDICAL PROGRAM, INC. ” Practice Location

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