Basic Information
| Provider Information | |||||||||
| NPI: | 1063715712 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RCHP-WILMINGTON, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 117054 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303687054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372839845 | ||||||||
| FaxNumber: | 9372839839 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451772125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372839845 | ||||||||
| FaxNumber: | 9372839839 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2010 | ||||||||
| LastUpdateDate: | 02/16/2022 | ||||||||
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| AuthorizedOfficialLastName: | TEAGUE | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT, CORPORATE SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 6292535121 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.