Provider Demographics
NPI:1154656411
Name:REGIONAL HEALTH DIAGNOSTICS INC
Entity Type:Organization
Organization Name:REGIONAL HEALTH DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:336-345-0678
Mailing Address - Street 1:PO BOX 1712
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27285-1712
Mailing Address - Country:US
Mailing Address - Phone:336-310-4712
Mailing Address - Fax:704-949-2610
Practice Address - Street 1:38 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3217
Practice Address - Country:US
Practice Address - Phone:910-333-8947
Practice Address - Fax:910-333-1266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ387840001Medicare PIN