=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164821450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGIONAL HEALTH PHYSICIANS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2014
-----------------------------------------------------
Last Update Date | 08/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 890 LAZELLE ST
-----------------------------------------------------
City | STURGIS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57785-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-347-3616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9263
-----------------------------------------------------
City | BELFAST
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04915-9263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-347-3616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER, RHP
-----------------------------------------------------
Name | JOHN Y PIERCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 605-755-9042
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------