MEDICARE: DR GINA REGHETTI DO PC 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	261Q00000X	Clinic/Center	34-006816-R	OH
2	261QH0100X	Health Service Clinic/Center	34-006816-R	OH
3	261QM0850X	Adult Mental Health Clinic/Center	34-006816-R	OH
4	261QM2500X	Medical Specialty Clinic/Center	34-006816-R	OH
5	261QP2300X	Primary Care Clinic/Center	34-006816-R	OH
6	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	34-006816-R	OH
7	261QM1300X	Multi-Specialty Clinic/Center	34-006816-R	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	RE 4018311	OTHER	OH	MEDICARE
8	H051310	OTHER	OH	MEDICARE ID AS OF 7-17-2013

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000012833-00	OTHER	OH	OHIO BUREAU OF WORKERS' COMPENSATION CERTIFIED
2	34-006816-R	OTHER	OH	STATE OF OHIO MEDICAL LICENSE # 34-006816-R
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	36D2026176	OTHER	OH	CLIA WAIVER CERTIFICATE # 36D2026176 ACUTE OPIOID DETOX CLINIC, U.S.A.
5	8873	OTHER	IL	AMERICAN OSTEOPATHIC BOARD OF FAMILY PHYSICIANS BOARD CERTIFICATION
7	064509	OTHER	OH	AOA # AMERICAN OSTEOPATHIC ASSOCIATION ID# 064509

General Provider Information

NPI Number	:	1841569902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR GINA REGHETTI DO PC INC

Provider Business Mailing Address
First Line	:	THE 110 BUILDING
Second Line	:	110 EDWARD STREET, NW
City	:	WARREN
State	:	OH
Zip	:	44483-1118
Country	:	US
Telephone Number	:	330-847-3334
Fax Number	:	330-847-9301

Provider Business Practice Location Address
First Line	:	THE 110 BUILDING
Second Line	:	110 EDWARD STREET, NW
City	:	WARREN
State	:	OH
Zip	:	44483-1118
Country	:	US
Telephone Number	:	330-847-3334
Fax Number	:	330-847-9301

Authorized Official
Title or Position	:	PHYSICIAN/SURGEON
Name	:	DR. DR. GINA REGHETTI
Credential	:	D.O.
Telephone Number	:	330-847-3334

Provider Enumeration Date	:	12/19/2011
Last Update Date	:	03/07/2023

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