Provider Demographics
NPI:1912996067
Name:PUTNAM COUNTY RURAL HEALTH CLINIC, INC
Entity Type:Organization
Organization Name:PUTNAM COUNTY RURAL HEALTH CLINIC, INC
Other - Org Name:MONTEREY RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KISSANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-858-2116
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:TN
Mailing Address - Zip Code:38544-0175
Mailing Address - Country:US
Mailing Address - Phone:931-858-2116
Mailing Address - Fax:931-858-2117
Practice Address - Street 1:117 W COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:TN
Practice Address - Zip Code:38574-1107
Practice Address - Country:US
Practice Address - Phone:931-839-6695
Practice Address - Fax:931-839-7023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3724161Medicare ID - Type Unspecified