Provider Demographics
NPI:1922394097
Name:REGENCE HEALTH NETWORK, INC.
Entity Type:Organization
Organization Name:REGENCE HEALTH NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-293-8561
Mailing Address - Street 1:2801 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-6737
Mailing Address - Country:US
Mailing Address - Phone:806-293-8561
Mailing Address - Fax:806-293-7354
Practice Address - Street 1:1301 S COULTER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1765
Practice Address - Country:US
Practice Address - Phone:806-322-3273
Practice Address - Fax:806-322-3274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P907OtherBCBS TX
TX312641901Medicaid
TX00P907OtherBCBS TX