Provider Demographics
NPI:1689758872
Name:RURAL HEALTHCARE PROVIDERS INC.
Entity Type:Organization
Organization Name:RURAL HEALTHCARE PROVIDERS INC.
Other - Org Name:SPARTA HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HELMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-634-3000
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MO
Mailing Address - Zip Code:65753-0449
Mailing Address - Country:US
Mailing Address - Phone:417-634-3000
Mailing Address - Fax:417-634-3001
Practice Address - Street 1:515 HUGH AVE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MO
Practice Address - Zip Code:65753-0449
Practice Address - Country:US
Practice Address - Phone:417-634-3000
Practice Address - Fax:417-634-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002008186207Q00000X
MODO36478207Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO593917701Medicaid
MO263886Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MO593917701Medicaid
MOA10395Medicare UPIN