Healthcare Provider Details

I. General information

NPI: 1053578799
Provider Name (Legal Business Name): REGIONAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STATE ST SUITE 301H
ERIE PA
16507-1427
US

IV. Provider business mailing address

300 STATE ST SUITE 301H
ERIE PA
16507-1427
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-5700
  • Fax: 814-877-5655
Mailing address:
  • Phone: 814-877-5700
  • Fax: 814-877-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID GIBBONS
Title or Position: PRESIDENT
Credential:
Phone: 814-877-7591