Provider Demographics
NPI:1629078498
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:BAILEYTON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/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 1:580 VAN HILL RD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-7608
Practice Address - Country:US
Practice Address - Phone:423-234-1020
Practice Address - Fax:423-234-0646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
3716670OtherCIGNA/MEDICARE
015OtherCHAMPUS PROVIDER
023398200OtherBLACK LUNG
TN4122525OtherBLUECROSS BLUESHIELD
TN4448311Medicaid
441803Medicare ID - Type UnspecifiedFQHC
TN4448311Medicaid