1053533539 NPI number — REGIONAL HEALTH CARE CLINIC INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053533539 NPI number — REGIONAL HEALTH CARE CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONAL HEALTH CARE CLINIC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053533539
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
821 WESTWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEDALIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-826-4774
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17571 N DAM ACCESS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARSAW
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65355-6396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-438-2717
Provider Business Practice Location Address Fax Number:
660-438-2313
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALLER
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
660-438-2717

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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