Basic Information
Provider Information | |||||||||
NPI: | 1326102716 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | RURAL HEALTH, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | WILLIAMSON COUNTY HEALTH CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 513 N MAIN ST | ||||||||
Address2: |   | ||||||||
City: | ANNA | ||||||||
State: | IL | ||||||||
PostalCode: | 629061668 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6188334471 | ||||||||
FaxNumber: | 6188338878 | ||||||||
Practice Location | |||||||||
Address1: | 3303 LOGAN DR | ||||||||
Address2: |   | ||||||||
City: | HERRIN | ||||||||
State: | IL | ||||||||
PostalCode: | 629483732 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6189935767 | ||||||||
FaxNumber: | 6189934005 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/20/2006 | ||||||||
LastUpdateDate: | 06/11/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FLAMM | ||||||||
AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
AuthorizedOfficialMiddleName: | K | ||||||||
AuthorizedOfficialTitleorPosition: | C. E. O. | ||||||||
AuthorizedOfficialTelephone: | 6188334471 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | RURAL HEALTH, INC. | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
ID | Type | State | Issuer | Description | 111760 | 01 | IL | HEALTHLINK | OTHER | 055761 | 01 | IL | HEALTH ALLIANCE | OTHER |