Basic Information
| Provider Information | |||||||||
| NPI: | 1720030232 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RURAL HEALTH GROUP, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RURAL HEALTH GROUP AT ROANOKE RAPIDS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 640 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE RAPIDS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278700640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525365791 | ||||||||
| FaxNumber: | 2525365444 | ||||||||
| Practice Location | |||||||||
| Address1: | 2066 HWY 125 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE RAPIDS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525365000 | ||||||||
| FaxNumber: | 2525362258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BEASLEY | ||||||||
| AuthorizedOfficialFirstName: | JUDY | ||||||||
| AuthorizedOfficialMiddleName: | BELCH | ||||||||
| AuthorizedOfficialTitleorPosition: | CORPORATE COMPLIANCE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2525365791 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 02609 | 01 | NC | BCBS OF NORTH CAROLINA | OTHER | 344593 | 05 | NC | MEDICAID |