Provider Demographics
NPI:1104827534
Name:PROHEALTH RURAL HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:PROHEALTH RURAL HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:615-866-6163
Mailing Address - Street 1:PO BOX 682589
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-2589
Mailing Address - Country:US
Mailing Address - Phone:615-591-4750
Mailing Address - Fax:615-465-6518
Practice Address - Street 1:1325 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3786
Practice Address - Country:US
Practice Address - Phone:615-866-6163
Practice Address - Fax:615-794-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN044-1891Medicaid
TN1505570Medicaid
TN044-1891Medicaid
TN1505570Medicaid
TN3900512Medicare PIN