Basic Information
| Provider Information | |||||||||
| NPI: | 1083180822 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REGIONAL HEALTH PHYSICIANS, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | REGIONAL HEALTH ORTHOPEDIC & SPECIALTY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 860013 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554860013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057556100 | ||||||||
| FaxNumber: | 6057556101 | ||||||||
| Practice Location | |||||||||
| Address1: | 1635 CAREGIVER CIRCLE | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057556100 | ||||||||
| FaxNumber: | 6057556101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2018 | ||||||||
| LastUpdateDate: | 12/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | LONGACRE | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AOSMH | ||||||||
| AuthorizedOfficialTelephone: | 6057558899 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 284300000X | Y | Hospitals | Special Hospital |
ID Information
| ID | Type | State | Issuer | Description | 68855 | 01 | SD | SD LICENSE | OTHER |