Healthcare Provider Details

I. General information

NPI: 1063715712
Provider Name (Legal Business Name): RCHP-WILMINGTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W MAIN ST
WILMINGTON OH
45177-2125
US

IV. Provider business mailing address

PO BOX 117054
ATLANTA GA
30368-7054
US

V. Phone/Fax

Practice location:
  • Phone: 937-283-9845
  • Fax: 937-283-9839
Mailing address:
  • Phone: 937-283-9845
  • Fax: 937-283-9839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY TEAGUE
Title or Position: VICE PRESIDENT, CORPORATE SECRETARY
Credential:
Phone: 629-253-5121