MICHIEL BRENT RUDDER


Address: 622 West Market Street, Bolivar, TN 38008
Phone: 7316584500

MICHIEL BRENT RUDDER (NPI# 1841287109) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1841287109
Entity Type Individual
Full Name MICHIEL BRENT RUDDER
Credential FNP MSW
Practice Address 622 West Market Street
Bolivar
TN 38008
Mailing Address Po Box 11567
Jackson
TN 38308-0126
Practice Telephone 7316584500
Practice Fax Number 7316584545
Mailing Telephone 7316610086
Mailing Fax Number 7316619702
Enumeration Date 2005-10-03
Last Update Date 2011-10-12
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207Q00000X Family Medicine RN131561 TN Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
TN 3909409 05
DEA MR0784276 01

Office Location

Street Address 622 WEST MARKET STREET
City BOLIVAR
State TN
Zip Code 38008

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1720639172 Shanna Shackelford Nurse Practitioner 11100 Old Hwy 64 W, Bolivar, TN 38008 2019-09-26
1598326233 Holly Brooke Shourd Family Medicine 1359 W Market St., Bolivar, TN 38008 2019-06-24
1992299234 Angela Dawn Haynes Registered Nurse 10825 Hwy 64w, Bolivar, TN 38008 2018-06-20
1326595919 Ashley Evon Jowers Nurse Practitioner 11100 Old Hwy 64 West, Bolivar, TN 38008 2016-09-01
1942458344 Anita Pearl Johnson Physical Therapy Assistant 700 Knuckolls Ave, Bolivar, TN 38008 2008-08-28
1841340007 State of Tennessee Public Health or Welfare 10825 Old Hwy 64, Bolivar, TN 38008 2007-01-11
1164479721 Betty Ragon Lenoir Physical Therapist 789 Tennessee St, Bolivar, TN 38008 2006-05-28
1689623050 County of Hardeman Ambulance 735 Naylor St, Bolivar, TN 38008 2006-05-10
1982606497 Richard Mast Reinhard IIi Pediatrics 629 Nuckolls Rd, Bolivar, TN 38008 2005-08-15
1700288024 Elizabeth Gault Ligon Optometrist 725 W Market St, Bolivar, TN 38008 2014-09-17
Find all providers in zip 38008

Taxonomy Information

Taxonomy Code 207Q00000X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine

Taxonomy Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition]
- Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences.
- Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1598326233 Holly Brooke Shourd Family Medicine 1359 W Market St., Bolivar, TN 38008 2019-06-24
1134255078 Robert Wayne Dunavant Family Medicine 610 Nuckolls Rd, Bolivar, TN 38008-1532 2007-02-26
1326110818 George J Heinz IIi Family Medicine 1500 N. Oakland Ave., Bolivar, MO 65613 2006-11-14
1871692798 Greg Link Family Medicine 3817 S Springfield Ave, Suite 140, Bolivar, MO 65613-9129 2006-09-21
1114930716 Monte R Kahler Family Medicine 1125 N Butterfield, Bolivar, MO 65613 2006-08-14
1023029998 Kristopher J Kaufmann Family Medicine 1125 N Butterfield Rd, Bolivar, MO 65613-1056 2006-08-10
1346283413 Associates In Medicine, Inc Family Medicine 630 E Buffalo St, Bolivar, MO 65613-2619 2006-06-14
1417901935 Juris Peteris Simanis Family Medicine 1155 W. Parkview Street, Suite 2d, Bolivar, MO 65613-7800 2006-05-20
1346201274 Stacey A Robertson Family Medicine 802 Mckinley St, Bolivar Medical Center, Bolivar, PA 15923 2006-03-30
1649248840 Mark Andrew Hillyer Family Medicine 10724 State Route 212 Ne, Bolivar, OH 44612-8740 2006-03-14
Find all providers in BOLIVAR

Competitor

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City BOLIVAR
Zip Code 38008

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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