MEDICARE: REGIONAL HEALTH SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1841457579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL HEALTH SERVICES INC.

Provider Business Mailing Address
First Line	:	717 STATE STREET
Second Line	:	SUITE 16, LL
City	:	ERIE
State	:	PA
Zip	:	16501-1360
Country	:	US
Telephone Number	:	814-480-7100
Fax Number	:	814-480-7604

Provider Business Practice Location Address
First Line	:	3330 PEACH STREET
Second Line	:	SUITE 106
City	:	ERIE
State	:	PA
Zip	:	16508-2771
Country	:	US
Telephone Number	:	814-877-5500
Fax Number	:	814-877-5508

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JASON N ROEBACK
Credential	:
Telephone Number	:	814-877-4242

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	06/16/2009

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