Provider Demographics
NPI:1639145204
Name:RURAL HEALTH RESOURCES OF JACKSON CO INC
Entity Type:Organization
Organization Name:RURAL HEALTH RESOURCES OF JACKSON CO INC
Other - Org Name:FAMILY PRACTICE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-364-2116
Mailing Address - Street 1:1110 COLUMBINE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-8824
Mailing Address - Country:US
Mailing Address - Phone:785-364-2126
Mailing Address - Fax:785-364-2801
Practice Address - Street 1:1110 COLUMBINE DR STE 100
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-8824
Practice Address - Country:US
Practice Address - Phone:785-364-2126
Practice Address - Fax:785-364-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS207Q00000X
KSH-043-001261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100244350EMedicaid
KS100244350BMedicaid
KS110707OtherBLUE CORSS GROUP PROVIDER
KS100244350BMedicaid