Rural Medical Services, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Parrottsville, TN
NPI 1669417481 · NPPES record last updated Jan 28, 2008
Key facts
- NPI
- 1669417481
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- RURAL MEDICAL SERVICES, INC.
- Practice address
- 111 Mockingbird Ave
Parrottsville, TN 37843 - Phone
- (423) 625-1170
- Fax
- (423) 625-3618
- NPI assigned
- Jun 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Larry A Stanifer
- Title
- Ceo
- Phone
- (865) 509-0055
Other NPIs on the same Medicare enrollment 7
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 8
Practitioners 33
-
Kristi Dale Bradshaw, FNP
-
Richard F Connelly, RNC, FNP
-
Brittany D Dixon, FNP
-
Jessica W Duncan, FNP
-
Jennifer Galyon, LPC-MHSP
-
Lucinda Hicks, NP
-
Kathryn R Hunt, MD
-
Chance Reed Linkous, APN-BC
-
Rachel A Mathers, RNC, FNP
-
Rachel McKinney, NP-C
-
Stephanie Posey, FNP-BC
-
Kristi Michelle Ryan, FNP
-
Maureen Carroll Smith, PSYD
-
Lawrence J Mathers, M.D.
-
Deana R Brotherton, M.D.
-
Melissa Rae Lamb, APRN,BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0659226 | Rural Medical Services, Inc Parrottsville Center | Provider-performed microscopy | May 25, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Federally qualified health center certification: CCN 441860
- Legal name
- RURAL MEDICAL SERVICES, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 1, 1992
- Last certification
- Apr 1, 1992
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 1, 1981 in TN
- Enrollment address
- 111 Mockingbird Ave
Parrottsville, TN 37843-2741
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Travis Hall |
Corporate Director |
Jan 1, 2023 | |
| Derrick Woods |
Corporate Director |
Jan 1, 2022 | |
| Josh Hartsell |
Corporate Director |
Jan 1, 2022 | |
| Jamie Clark |
Corporate Director |
Jan 1, 2022 | |
| Sam Moscato |
Corporate Director |
Jan 1, 2022 | |
| Leslie J Childress |
Corporate Director |
Jan 1, 2022 | |
| Amy Bradshaw |
Corporate Director |
Aug 1, 2025 | |
| W-2 Managing Employee |
Aug 1, 2025 | ||
| Bonnie Ezell |
Corporate Director |
Jan 1, 2022 | |
| Crystal Chambers |
Corporate Director |
Jan 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050914001081 | TN | Part B Supplier - Clinic/Group Practice | 1456384080 |
Receives reassigned benefits from 24 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: White Pine, TN; Parrottsville, TN; Newport, TN; Jefferson City, TN; Hartford, TN; Dandridge, TN |
| O20071226000139 | TN | Part a Provider - Federally Qualified Health Center (FQHC) | 1456384080 | Practice locations: Parrottsville, TN |
National Provider Directory
- Tax ID family
- Rural Medical Services Inc
Locations
111 Mockingbird Ave
Parrottsville, TN 37843
Phone (423) 625-1170
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
111 Mockingbird Ave
Parrottsville, TN 37843
Mailing address
PO Box 99
Parrottsville, TN 37843-0099
Phone (423) 625-1170
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0441860 | Medicaid | TN |
Other names
- Parrottsville Center
Other providers in Parrottsville, TN
- Hollie Coates-Hensley
- Patricia J Conner
- Stephen Robert Manock
- Newport Surgical, Inc.
- Norman Lincoln Shaffer
- Zachary Smith
All providers in Parrottsville, TN · Federally Qualified Health Center (FQHC) in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.