Provider Demographics
NPI:1912350067
Name:RURALMED LLC
Entity Type:Organization
Organization Name:RURALMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-245-1052
Mailing Address - Street 1:100 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:FARINA
Mailing Address - State:IL
Mailing Address - Zip Code:62838-1282
Mailing Address - Country:US
Mailing Address - Phone:618-245-1052
Mailing Address - Fax:
Practice Address - Street 1:100 S OAK ST
Practice Address - Street 2:
Practice Address - City:FARINA
Practice Address - State:IL
Practice Address - Zip Code:62838-1282
Practice Address - Country:US
Practice Address - Phone:618-245-1052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance