Provider Demographics
NPI:1366506628
Name:RURAL HEALTH, INC.
Entity Type:Organization
Organization Name:RURAL HEALTH, INC.
Other - Org Name:DONGOLA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C. E. O.
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FLAMM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:618-833-4471
Mailing Address - Street 1:513 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-1668
Mailing Address - Country:US
Mailing Address - Phone:618-833-4471
Mailing Address - Fax:618-833-8878
Practice Address - Street 1:318 N US HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:DONGOLA
Practice Address - State:IL
Practice Address - Zip Code:62926
Practice Address - Country:US
Practice Address - Phone:618-827-3545
Practice Address - Fax:618-827-4891
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RURAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9115001OtherBLUE CROSS BLUE SHIELD
IL111760OtherHEALTHLINK
IL055761OtherHEALTH ALLIANCE
IL9115001OtherBLUE CROSS BLUE SHIELD
IL055761OtherHEALTH ALLIANCE
IL141817Medicare Oscar/Certification