Provider Demographics
NPI:1891872834
Name:BUDE RURAL HEALTH CLINIC
Entity Type:Organization
Organization Name:BUDE RURAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-384-2394
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:BUDE
Mailing Address - State:MS
Mailing Address - Zip Code:39630
Mailing Address - Country:US
Mailing Address - Phone:601-384-2394
Mailing Address - Fax:601-384-4199
Practice Address - Street 1:136 MAIN ST N
Practice Address - Street 2:
Practice Address - City:BUDE
Practice Address - State:MS
Practice Address - Zip Code:39630
Practice Address - Country:US
Practice Address - Phone:601-384-2394
Practice Address - Fax:601-384-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014263Medicaid
253966Medicare Oscar/Certification