NPIMap

Organization Active NPI

Rural Medical Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Newport, TN
National Provider Identifier
1801045380
Registry record updated Sep 9, 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
207 Murray Dr
Newport, TN 37821-3631
Phone
(423) 613-1360
Fax
(423) 613-1361
NPI assigned
Sep 9, 2008
Last updated
Sep 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 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 NU Primary

Addresses

Primary practice location

207 Murray Dr
Newport, TN 37821-3631

Mailing address

207 Murray Dr
Newport, TN 37821-3631
Phone (423) 613-1360

Other names 1

  • Mobile Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080930000143 TN Part A Provider - Federally Qualified Health Center (FQHC) 1456384080 Practice locations: Newport, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801045380. Details of each certification follow.

Federally qualified health center certification: CCN 441923

Legal name
RURAL MEDICAL SERVICES, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 17, 2008
Last certification
Nov 17, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1981 in TN
Enrollment address
207 Murray Dr
Newport, TN 37821-3631

Other NPIs with the same Medicare PAC ID 6

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

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 Aug 1, 2025
Bonnie Ezell Individual Corporate DirectorBoard Member Jan 1, 2022
Crystal Chambers Individual Corporate DirectorBoard Member Jan 1, 2023

NPI Registry JSON

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

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220918400000",
    "number": "1801045380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 MURRAY DR",
            "city": "NEWPORT",
            "state": "TN",
            "postal_code": "378213631",
            "telephone_number": "423-613-1360",
            "fax_number": "423-613-1361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 MURRAY DR",
            "city": "NEWPORT",
            "state": "TN",
            "postal_code": "378213631",
            "telephone_number": "423-613-1360",
            "fax_number": "423-613-1361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL MEDICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-09",
        "last_updated": "2008-09-09",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobile Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Newport, TN

Sources for this page

Verify at the official NPI Registry.