Provider Demographics
NPI:1386858132
Name:REGIONAL HEALTH PHYSICIANS INC
Entity type:Organization
Organization Name:REGIONAL HEALTH PHYSICIANS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-719-8394
Mailing Address - Street 1:1445 NORTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1552
Mailing Address - Country:US
Mailing Address - Phone:605-644-4170
Mailing Address - Fax:605-644-4198
Practice Address - Street 1:2200 13TH AVE
Practice Address - Street 2:
Practice Address - City:BELLE FOURCHE
Practice Address - State:SD
Practice Address - Zip Code:57717-2215
Practice Address - Country:US
Practice Address - Phone:605-892-3331
Practice Address - Fax:605-892-0204
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL HEALTH PHYSICIANS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-10
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS100939Medicare PIN