Provider Demographics
NPI:1437574613
Name:RURAL HEALTH PLLC
Entity Type:Organization
Organization Name:RURAL HEALTH PLLC
Other - Org Name:BEREA WALK-IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-312-9674
Mailing Address - Street 1:245 PRINCE ROYAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1471
Mailing Address - Country:US
Mailing Address - Phone:859-582-7663
Mailing Address - Fax:859-335-1560
Practice Address - Street 1:245 PRINCE ROYAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1471
Practice Address - Country:US
Practice Address - Phone:859-582-7663
Practice Address - Fax:859-335-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32006207R00000X
KYPA1103363A00000X
KY3008382363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty