Provider Demographics
NPI:1700045820
Name:RURAL HEALTH GROUP, INC.
Entity Type:Organization
Organization Name:RURAL HEALTH GROUP, INC.
Other - Org Name:RURAL HEALTH GROUP AT NORLINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-536-5871
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0640
Mailing Address - Country:US
Mailing Address - Phone:252-536-5440
Mailing Address - Fax:252-536-5444
Practice Address - Street 1:110 DIVISION STREET
Practice Address - Street 2:
Practice Address - City:NORLINA
Practice Address - State:NC
Practice Address - Zip Code:27563-0149
Practice Address - Country:US
Practice Address - Phone:252-456-2009
Practice Address - Fax:252-456-2889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02153OtherBLUE CROSS BLUE SHIELD
NC344002A/CMedicaid
NC=========005OtherTRICARE
WI341932Medicare Oscar/Certification
NC=========005OtherTRICARE