Provider Demographics
NPI:1003230541
Name:REGIONAL HEALTH PHYSICIANS, INC.
Entity Type:Organization
Organization Name:REGIONAL HEALTH PHYSICIANS, INC.
Other - Org Name:WALL REGIONAL MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-755-9042
Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7375
Mailing Address - Country:US
Mailing Address - Phone:605-755-9142
Mailing Address - Fax:605-755-9140
Practice Address - Street 1:112 7TH AVENUE
Practice Address - Street 2:
Practice Address - City:WALL
Practice Address - State:SD
Practice Address - Zip Code:57790
Practice Address - Country:US
Practice Address - Phone:605-279-2149
Practice Address - Fax:605-279-2139
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-04
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS300040Medicaid
SDS300040Medicaid