Healthcare Provider Details

I. General information

NPI: 1932533619
Provider Name (Legal Business Name): REGIONAL HEALTH PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 PINE STREET
UPTON WY
82730
US

IV. Provider business mailing address

353 FAIRMONT BLVD
RAPID CITY SD
57701-7375
US

V. Phone/Fax

Practice location:
  • Phone: 307-746-3582
  • Fax:
Mailing address:
  • Phone: 605-755-9042
  • Fax: 605-755-9040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2919A
License Number StateWY

VIII. Authorized Official

Name: JOHN Y PIERCE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 605-755-9042