Provider Demographics
NPI:1902995145
Name:RURAL HEALTH GROUP INC
Entity Type:Organization
Organization Name:RURAL HEALTH GROUP INC
Other - Org Name:RURAL HEALTH GROUP AT TWIN COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-537-5842
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:NC
Mailing Address - Zip Code:27844-0010
Mailing Address - Country:US
Mailing Address - Phone:252-586-5151
Mailing Address - Fax:252-586-6932
Practice Address - Street 1:204 EVANS ROAD
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:NC
Practice Address - Zip Code:27844-0010
Practice Address - Country:US
Practice Address - Phone:252-586-5151
Practice Address - Fax:252-586-6932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344533AMedicaid
NC03054OtherBC/BS OF NORTH CAROLINA
NC344533AMedicaid
WI341911Medicare Oscar/Certification