Healthcare Provider Details

I. General information

NPI: 1639403843
Provider Name (Legal Business Name): REGIONAL HEALTH NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 MONTGOMERY ST
CUSTER SD
57730-1304
US

IV. Provider business mailing address

PO BOX 3450
RAPID CITY SD
57709-3450
US

V. Phone/Fax

Practice location:
  • Phone: 605-673-4150
  • Fax:
Mailing address:
  • Phone: 605-673-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY H SUGHRUE
Title or Position: COO-RCRH EXECUTIVE MANAGEMENT
Credential:
Phone: 605-719-8162