Provider Demographics
NPI:1962443697
Name:RURAL MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:RURAL MEDICAL SERVICES, INC.
Other - Org Name:COSBY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STANIFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-509-0055
Mailing Address - Street 1:103 WILTON SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821
Mailing Address - Country:US
Mailing Address - Phone:423-487-2222
Mailing Address - Fax:423-623-7787
Practice Address - Street 1:103 WILTON SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821
Practice Address - Country:US
Practice Address - Phone:423-487-2222
Practice Address - Fax:423-623-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0441859Medicaid
TN0441859Medicaid
44-1859Medicare ID - Type UnspecifiedFQHC MEDICARE #