Healthcare Provider Details

I. General information

NPI: 1801138078
Provider Name (Legal Business Name): REGIONAL HEALTH PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S GALENA AVE
WYOMING IL
61491-1470
US

IV. Provider business mailing address

1258 W SOUTH ST STE 2
KEWANEE IL
61443-8300
US

V. Phone/Fax

Practice location:
  • Phone: 309-695-6448
  • Fax: 309-695-6447
Mailing address:
  • Phone: 309-853-3677
  • Fax: 309-853-3692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. AMANDA C OLDEROG
Title or Position: DIRECTOR OF BUSINESS OPERATIONS
Credential:
Phone: 563-742-2024