MEDICARE: REGIONAL HEALTH NETWORK 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	261QE0002X	Emergency Care Clinic/Center	47660	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	47660	OTHER	SD	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558459073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL HEALTH NETWORK INC

Provider Business Mailing Address
First Line	:	PO BOX 860013
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55486-0013
Country	:	US
Telephone Number	:	605-673-2229
Fax Number	:

Provider Business Practice Location Address
First Line	:	1039 MONTGOMERY ST
Second Line	:
City	:	CUSTER
State	:	SD
Zip	:	57730-1304
Country	:	US
Telephone Number	:	605-673-2229
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	PAULETTE DAVIDSON
Credential	:
Telephone Number	:	605-755-9138

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	03/13/2018

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