Provider Demographics
NPI:1568462372
Name:RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC
Entity Type:Organization
Organization Name:RURAL HEALTH SERVICES CONSORTIUM OF UPPER EAST TENNESSEE INC
Other - Org Name:ROAN MOUNTAIN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:W
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-272-9163
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0850
Mailing Address - Country:US
Mailing Address - Phone:423-272-9163
Mailing Address - Fax:423-921-6920
Practice Address - Street 1:152 HIGHWAY 143
Practice Address - Street 2:
Practice Address - City:ROAN MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37687-3002
Practice Address - Country:US
Practice Address - Phone:423-772-3276
Practice Address - Fax:423-772-4816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4122525OtherBLUECROSS BLUESHIELD
005OtherCHAMPUS PROVIDER
020250900OtherBLACKLUNG
TN4448070Medicaid
005OtherCHAMPUS PROVIDER
3703860Medicare ID - Type UnspecifiedCIGNA
3703865Medicare PIN