Basic Information
| Provider Information | |||||||||
| NPI: | 1629253588 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REGIONAL HEALTH PHYSCIANS INC | ||||||||
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| OtherOrganizationName: | QUEEN CITY REGIONAL MEDICAL CLINIC AND SPRMC DERMATOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 353 FAIRMONT BLVD | ||||||||
| Address2: | ATTEN MEDICAL STAFF SERVICES | ||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577016000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057197109 | ||||||||
| FaxNumber: | 6057191027 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 EAST COLORADO BLVD | ||||||||
| Address2: | |||||||||
| City: | SPEARFISH | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577832776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057178860 | ||||||||
| FaxNumber: | 6057178861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2008 | ||||||||
| LastUpdateDate: | 08/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | CHRISTIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER ENROLLMENT COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 6057197109 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.