Provider Demographics
NPI:1831353754
Name:RURAL HEALTH CARE SERVICES LLC
Entity type:Organization
Organization Name:RURAL HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-844-3232
Mailing Address - Street 1:2566 MAIN ST
Mailing Address - Street 2:P.O. BOX 128
Mailing Address - City:PLANTERSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38862-7908
Mailing Address - Country:US
Mailing Address - Phone:662-844-3232
Mailing Address - Fax:662-844-3291
Practice Address - Street 1:2566 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLANTERSVILLE
Practice Address - State:MS
Practice Address - Zip Code:38862-7908
Practice Address - Country:US
Practice Address - Phone:662-844-3232
Practice Address - Fax:662-844-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05113261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS25D0685868OtherCLIA
MSD00811Medicare UPIN