Basic Information
| Provider Information | |||||||||
| NPI: | 1164690954 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REGIONAL HEALTH SERVICES, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GLENWOOD FAMILY PRACTICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 717 STATE ST | ||||||||
| Address2: | SUITE 16, LL | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165011341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144807100 | ||||||||
| FaxNumber: | 8144807604 | ||||||||
| Practice Location | |||||||||
| Address1: | 3330 PEACH ST | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165082769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148775500 | ||||||||
| FaxNumber: | 8148775508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2008 | ||||||||
| LastUpdateDate: | 02/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | FIORENZO | ||||||||
| AuthorizedOfficialFirstName: | V | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT, REGIONAL HEALTH SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 8148776588 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 1007293220169 | 05 | PA | MEDICAID |