MEDICARE: REGIS HEALTHCARE INC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	P07501	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1832888	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1356616007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIS HEALTHCARE INC

Provider Business Mailing Address
First Line	:	2208 FORT CAMPBELL BLVD
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-4665
Country	:	US
Telephone Number	:	270-885-5515
Fax Number	:	270-885-5591

Provider Business Practice Location Address
First Line	:	2208 FORT CAMPBELL BLVD
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-4665
Country	:	US
Telephone Number	:	270-885-5515
Fax Number	:	270-885-5591

Authorized Official
Title or Position	:	PHARMICIST
Name	:	WILLIAM REED GINN
Credential	:
Telephone Number	:	270-885-5515

Provider Enumeration Date	:	03/14/2012
Last Update Date	:	04/12/2017

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Directions to “REGIS HEALTHCARE INC ” Practice Location

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