Provider Demographics
NPI:1639403843
Name:REGIONAL HEALTH NETWORK INC
Entity Type:Organization
Organization Name:REGIONAL HEALTH NETWORK INC
Other - Org Name:CUSTER REGIONAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO-RCRH EXECUTIVE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:H
Authorized Official - Last Name:SUGHRUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-719-8162
Mailing Address - Street 1:PO BOX 3450
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-3450
Mailing Address - Country:US
Mailing Address - Phone:605-673-4150
Mailing Address - Fax:
Practice Address - Street 1:1041 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:SD
Practice Address - Zip Code:57730-1304
Practice Address - Country:US
Practice Address - Phone:605-673-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL HEALTH NETWORK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-22
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS40254Medicare PIN