Provider Demographics
NPI:1861492431
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:HANCOCK MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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 1:300 RIVER RD
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869-3806
Practice Address - Country:US
Practice Address - Phone:423-733-2061
Practice Address - Fax:423-733-1965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4448312Medicaid
020365600OtherBLACKLUNG
3716671OtherCIGNA/MEDICARE
TN4122525OtherBLUECROSS BLUSHIELD
028OtherCHAMPUS PROVIDER
020365600OtherBLACKLUNG
441872Medicare ID - Type Unspecified