Provider Demographics
NPI:1235305954
Name:HARRY R. RUTH, M.D.,P.C.
Entity Type:Organization
Organization Name:HARRY R. RUTH, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-228-3377
Mailing Address - Street 1:1107 COLLEGE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2664
Mailing Address - Country:US
Mailing Address - Phone:217-228-3377
Mailing Address - Fax:217-228-2657
Practice Address - Street 1:1107 COLLEGE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2664
Practice Address - Country:US
Practice Address - Phone:217-228-3377
Practice Address - Fax:217-228-2657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068434207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068434Medicaid
MO202444915OtherMEDICAID
243437OtherHEALTHLINK
IL00122928OtherBLUE CROSS BLUE SHIELD
IL036068434Medicaid