Provider Demographics
NPI:1679819387
Name:REGIONAL HEALTH PARTNERS LLC
Entity Type:Organization
Organization Name:REGIONAL HEALTH PARTNERS LLC
Other - Org Name:REGIONAL GENERAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-528-2801
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-2403
Mailing Address - Country:US
Mailing Address - Phone:352-528-2801
Mailing Address - Fax:352-528-1493
Practice Address - Street 1:125 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2403
Practice Address - Country:US
Practice Address - Phone:352-528-2801
Practice Address - Fax:352-528-1493
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL HEALTH PARTNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-27
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4424282NR1301X, 282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010114100Medicaid
FL010114100Medicaid