Provider Demographics
NPI:1982156139
Name:RURALBASICSHC INC
Entity Type:Organization
Organization Name:RURALBASICSHC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:DENAY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:507-884-0651
Mailing Address - Street 1:131 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:WABASHA
Mailing Address - State:MN
Mailing Address - Zip Code:55981-1236
Mailing Address - Country:US
Mailing Address - Phone:507-884-0651
Mailing Address - Fax:651-565-4863
Practice Address - Street 1:131 MAIN ST W
Practice Address - Street 2:
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981-1236
Practice Address - Country:US
Practice Address - Phone:507-884-0651
Practice Address - Fax:651-565-4863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care