| Rural Health Clinic | |
|
557 W Park Pl Henderson TN 38340-2027 | |
| (731) 989-1007 | |
| (731) 988-0704 |
| Full Name | Rural Health Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 557 W Park Pl, Henderson, Tennessee |
| Authorized Official Name and Position | Cameron S Burks (OFFICE MANAGER) |
| Authorized Official Contact | 7319891007 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rural Health Clinic 557 W Park Pl Henderson TN 38340-2027 Ph: (731) 989-1007 | Rural Health Clinic 557 W Park Pl Henderson TN 38340-2027 Ph: (731) 989-1007 |
| NPI Number | 1073906616 |
|---|---|
| Provider Enumeration Date | 03/06/2015 |
| Last Update Date | 07/23/2020 |
| Medicare PECOS PAC ID | 5092702498 |
|---|---|
| Medicare Enrollment ID | O20040428000358 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073906616 | NPI | - | NPPES |
| 443960 | Other | TN | MEDICARE PTAN FOR RURAL HEALTH CLINIC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Mohsin T Alhaddad |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1467624619 PECOS PAC ID: 6406036201 Enrollment ID: I20121011000492 |
| Provider Name | Cara R Roberson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093057465 PECOS PAC ID: 6800038985 Enrollment ID: I20130820000885 |
| Provider Name | Brooke Lacy Garner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518475656 PECOS PAC ID: 8820348535 Enrollment ID: I20180829004759 |
| Provider Name | Trent Jim-e Theriac |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134686116 PECOS PAC ID: 0840533311 Enrollment ID: I20190524000631 |
| Provider Name | Ehtesham Ul Haq |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1194055137 PECOS PAC ID: 3971733445 Enrollment ID: I20200720003606 |
| Provider Name | Suzanne Rae Morris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043814304 PECOS PAC ID: 0446664460 Enrollment ID: I20210202001248 |
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