Basic Information
| Provider Information | |||||||||
| NPI: | 1609823749 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REGIONAL HEALTH PHYSICIANS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SPEARFISH REGIONAL SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1316 N 10TH ST | ||||||||
| Address2: | |||||||||
| City: | SPEARFISH | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577831530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056423113 | ||||||||
| FaxNumber: | 6056423117 | ||||||||
| Practice Location | |||||||||
| Address1: | 1316 N 10TH ST | ||||||||
| Address2: | |||||||||
| City: | SPEARFISH | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577831530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056423113 | ||||||||
| FaxNumber: | 6056423117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 01/26/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HARLAN | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | FINANCE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6056423113 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 282N00000X | 11151 | SD | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 114951200 | 05 | WY | MEDICAID | 20184 | 01 | SD | DAKOTACARE PROVIDER NUMBE | OTHER | 5508060 | 05 | SD | MEDICAID | 80094 | 01 | SD | BCBS PROVIDER NUMBER | OTHER | 0108060 | 05 | SD | MEDICAID | 412139 | 05 | MT | MEDICAID |