Provider Demographics
NPI:1376830869
Name:RICHWOOD RURAL HEALTH CENTER
Entity Type:Organization
Organization Name:RICHWOOD RURAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:TENNANT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:318-516-7737
Mailing Address - Street 1:5713 BON AIRE DR
Mailing Address - Street 2:P.O. BOX 1428
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-3226
Mailing Address - Country:US
Mailing Address - Phone:318-516-7737
Mailing Address - Fax:318-387-9308
Practice Address - Street 1:5713 BON AIRE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-3226
Practice Address - Country:US
Practice Address - Phone:318-537-2854
Practice Address - Fax:318-387-9308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care