NPIMap

Organization Active NPI

Rural Health Medical Program, Inc

Doing business as Vredenburgh Health Center

  • Federally Qualified Health Center (FQHC)
  • Vredenburgh, AL
National Provider Identifier
1104995208
Registry record updated Dec 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RURAL HEALTH MEDICAL PROGRAM, INC
Doing business as
Vredenburgh Health Center
Practice address
558 County Road 56
Vredenburgh, AL 36481-0494
Phone
(334) 337-4787
Fax
(334) 337-4682
NPI assigned
Nov 6, 2006
Last updated
Dec 21, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
RURAL HEALTH MEDICAL PROGRAM, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 21, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Patricia Gibson
Title
Ceo
Phone
(334) 874-7428

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X AL Primary

Addresses

Primary practice location

558 County Road 56
Vredenburgh, AL 36481-0494

Mailing address

P O Box 2213
228 Selma Avenue
Selma, AL 36702-2213
Phone (334) 874-7428

Other identifiers 2

IdentifierTypeStateIssuer
011890OtherALMEDICARE ID - TYPE UNSPECIFIED
630000008MedicaidAL

Other names 1

  • Vredenburgh Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040506001178 AL Part B Supplier - Clinic/Group Practice 0143219196 Receives reassigned benefits from 42 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Demopolis, AL; Marion, AL; Monroeville, AL; Pine Apple, AL; Selma, AL; Thomaston, AL; Uniontown, AL; Vredenburgh, AL…

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Rural HLTH Medical Prog

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292889600000",
    "number": "1104995208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 2213",
            "address_2": "228 SELMA AVENUE",
            "city": "SELMA",
            "state": "AL",
            "postal_code": "367022213",
            "telephone_number": "334-874-7428",
            "fax_number": "334-874-7435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "558 COUNTY ROAD 56",
            "city": "VREDENBURGH",
            "state": "AL",
            "postal_code": "364810494",
            "telephone_number": "334-337-4787",
            "fax_number": "334-337-4682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH MEDICAL PROGRAM, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RURAL HEALTH MEDICAL PROGRAM, INC.",
        "enumeration_date": "2006-11-06",
        "last_updated": "2010-12-21",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "334-874-7428",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID - TYPE UNSPECIFIED",
            "identifier": "011890",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630000008",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vredenburgh Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vredenburgh, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.