Basic Information
| Provider Information | |||||||||
| NPI: | 1700090560 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REGIONAL HEALTH PHYSICIANS INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | NEWELL REGIONAL MEDICAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1445 NORTH AVENUE | ||||||||
| Address2: | |||||||||
| City: | SPEARFISH | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577831552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056444170 | ||||||||
| FaxNumber: | 6056444198 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 EAST THIRD STREET | ||||||||
| Address2: | |||||||||
| City: | NEWELL | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577600468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6054562462 | ||||||||
| FaxNumber: | 6054561001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 04/21/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PIERCE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | Y | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6057198394 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | REGIONAL HEALTH PHYSICIANS INC | ||||||||
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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.