MEDICARE: REGIONAL HEALTH MANAGEMENT CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DO1091	AL

General Provider Information

NPI Number	:	1285915934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL HEALTH MANAGEMENT CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 2345
Second Line	:
City	:	ANNISTON
State	:	AL
Zip	:	36202-2345
Country	:	US
Telephone Number	:	256-741-1198
Fax Number	:	256-235-5608

Provider Business Practice Location Address
First Line	:	1654 PELHAM RD S
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-3312
Country	:	US
Telephone Number	:	256-741-1198
Fax Number	:	256-235-5608

Authorized Official
Title or Position	:	VP PRACTICE DEVELOPMENT
Name	:	MR. JAMES LIPSCOMB
Credential	:
Telephone Number	:	256-741-1198

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	09/07/2011

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