Healthcare Provider Details

I. General information

NPI: 1376014407
Provider Name (Legal Business Name): REGIONAL HEALTH PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 FAIRMONT BLVD
RAPID CITY SD
57701-6360
US

IV. Provider business mailing address

PO BOX 860013
MINNEAPOLIS MN
55486-0013
US

V. Phone/Fax

Practice location:
  • Phone: 605-719-1100
  • Fax:
Mailing address:
  • Phone: 605-719-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MARK LONGACRE
Title or Position: PRESIDENT AOSMH
Credential:
Phone: 605-755-8899