Provider Demographics
NPI:1871537639
Name:RURAL MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:RURAL MEDICAL SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STANIFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-509-0055
Mailing Address - Street 1:4261 BIG CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:TN
Mailing Address - Zip Code:37753-2220
Mailing Address - Country:US
Mailing Address - Phone:423-487-2249
Mailing Address - Fax:423-487-3707
Practice Address - Street 1:4261 BIG CREEK RD
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:TN
Practice Address - Zip Code:37753-2220
Practice Address - Country:US
Practice Address - Phone:423-487-2249
Practice Address - Fax:423-487-3707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0441858Medicaid
44-1858Medicare ID - Type UnspecifiedFQHC MEDICARE #
TN0441858Medicaid