Provider Demographics
NPI:1548693138
Name:REGIONAL HEALTH PHYSICIANS, INC.
Entity type:Organization
Organization Name:REGIONAL HEALTH PHYSICIANS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-755-9042
Mailing Address - Street 1:717 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:WY
Mailing Address - Zip Code:82730
Mailing Address - Country:US
Mailing Address - Phone:307-468-2302
Mailing Address - Fax:
Practice Address - Street 1:717 PINE STREET
Practice Address - Street 2:
Practice Address - City:UPTON
Practice Address - State:WY
Practice Address - Zip Code:82730
Practice Address - Country:US
Practice Address - Phone:307-468-2302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-19
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY533807Medicare PIN