Basic Information
| Provider Information | |||||||||
| NPI: | 1962763045 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RURAL HEALTH, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GOREVILLE MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 513 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ANNA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629061668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6188334471 | ||||||||
| FaxNumber: | 6188338878 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 S BROADWAY | ||||||||
| Address2: | |||||||||
| City: | GOREVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629392444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189951002 | ||||||||
| FaxNumber: | 6189951133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2012 | ||||||||
| LastUpdateDate: | 04/25/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FLAMM | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6188334471 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MSW, LCSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.