Provider Demographics
NPI:1255428470
Name:RURAL HEALTH ASSOCIATES LLP
Entity type:Organization
Organization Name:RURAL HEALTH ASSOCIATES LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-848-4777
Mailing Address - Street 1:14477 CABERFAE HWY
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:MI
Mailing Address - Zip Code:49689-9315
Mailing Address - Country:US
Mailing Address - Phone:231-848-4777
Mailing Address - Fax:
Practice Address - Street 1:14477 CABERFAE HWY
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:MI
Practice Address - Zip Code:49689-9315
Practice Address - Country:US
Practice Address - Phone:231-848-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-08
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
233918Medicare Oscar/Certification