NPIMap

Organization Active NPI

Rural Medical Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Parrottsville, TN
National Provider Identifier
1669417481
Registry record updated Jan 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Jan 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2008

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

Authorized official

Name
Mr. Larry A Stanifer
Title
Ceo
Phone
(865) 509-0055

Specialties & licenses 1

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

Addresses

Primary practice location

111 Mockingbird Ave
Parrottsville, TN 37843

Mailing address

PO Box 99
Parrottsville, TN 37843-0099
Phone (423) 625-1170

Other names 1

  • Parrottsville Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669417481. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jan 1, 1981 in TN
Enrollment address
111 Mockingbird Ave
Parrottsville, TN 37843-2741

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D0659226Rural Medical Services, Inc Parrottsville Center111 Mockingbird Avenue, Parrottsville, TN 37843Provider-performed microscopyMay 25, 2028

National Provider Directory

National Provider Directory
Tax ID family
Rural Medical Services Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Travis Hall Individual Corporate DirectorBoard Member Jan 1, 2023
Derrick Woods Individual Corporate DirectorBoard Member Jan 1, 2022
Josh Hartsell Individual Corporate DirectorBoard Member Jan 1, 2022
Jamie Clark Individual Corporate DirectorBoard Member Jan 1, 2022
Sam Moscato Individual Corporate DirectorBoard Member Jan 1, 2022
Leslie J Childress Individual Corporate DirectorBoard Member Jan 1, 2022
Amy Bradshaw Individual Corporate DirectorInterim Ceo Aug 1, 2025
W-2 Managing EmployeeInterim Ceo, Cfo Aug 1, 2025
Bonnie Ezell Individual Corporate DirectorBoard Member Jan 1, 2022
Crystal Chambers Individual Corporate DirectorBoard Member Jan 1, 2023

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201478400000",
    "number": "1669417481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99",
            "city": "PARROTTSVILLE",
            "state": "TN",
            "postal_code": "378430099",
            "telephone_number": "423-625-1170",
            "fax_number": "423-625-3618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MOCKINGBIRD AVE",
            "city": "PARROTTSVILLE",
            "state": "TN",
            "postal_code": "37843",
            "telephone_number": "423-625-1170",
            "fax_number": "423-625-3618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL MEDICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2008-01-28",
        "status": "A",
        "authorized_official_last_name": "STANIFER",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "865-509-0055",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parrottsville Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Parrottsville, TN

Sources for this page

Verify at the official NPI Registry.