Provider Demographics
NPI:1609937515
Name:RURAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:RURAL HEALTH SERVICES, INC.
Other - Org Name:MARGARET J. WESTON DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:803-593-9283
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:SC
Mailing Address - Zip Code:29822-0277
Mailing Address - Country:US
Mailing Address - Phone:803-593-9283
Mailing Address - Fax:803-593-0607
Practice Address - Street 1:4645 AUGUSTA ROAD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:SC
Practice Address - Zip Code:29822
Practice Address - Country:US
Practice Address - Phone:803-593-9283
Practice Address - Fax:803-593-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC166100Medicaid