Provider Demographics
NPI:1396794319
Name:ROLLING PLAINS RURAL HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:ROLLING PLAINS RURAL HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KASSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-235-8641
Mailing Address - Street 1:201 E ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-7119
Mailing Address - Country:US
Mailing Address - Phone:325-235-8641
Mailing Address - Fax:325-235-5925
Practice Address - Street 1:201 E ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-7119
Practice Address - Country:US
Practice Address - Phone:325-235-8641
Practice Address - Fax:325-235-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0634446-01Medicaid
TX45-3947Medicare ID - Type UnspecifiedMEDICARE A GROUP NUMBER