Basic Information
| Provider Information | |||||||||
| NPI: | 1861876278 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REGIONAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23756 ARENA DR | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577027302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012139032 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2116 JACKSON BLVD | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577023495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057552273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2015 | ||||||||
| LastUpdateDate: | 07/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | TROY | ||||||||
| AuthorizedOfficialMiddleName: | NEIL | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 7012139032 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.