Provider Demographics
NPI:1205105491
Name:THE CENTER FOR RURAL HEALTH INNOVATION
Entity type:Organization
Organization Name:THE CENTER FOR RURAL HEALTH INNOVATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-284-1541
Mailing Address - Street 1:167 LOCUST ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777-2702
Mailing Address - Country:US
Mailing Address - Phone:828-467-8815
Mailing Address - Fax:828-367-7827
Practice Address - Street 1:167 LOCUST ST STE 204
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-2702
Practice Address - Country:US
Practice Address - Phone:828-467-8815
Practice Address - Fax:828-367-7827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235013207QA0000X, 208000000X, 207Q00000X
363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC235013OtherMEDICAL LICENSE