1902862592 NPI number — REGIONAL HEALTH CENTER OF RICHMOND, INC.

Table of content: (NPI 1902862592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902862592 NPI number — REGIONAL HEALTH CENTER OF RICHMOND, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONAL HEALTH CENTER OF RICHMOND, 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:
SPICER HEALTH CENTER, INC.
Provider Other Organization Name Type Code:
4
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:
1902862592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 IVY AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-597-8999
Provider Business Mailing Address Fax Number:
320-597-8995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 IVY AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-597-8999
Provider Business Practice Location Address Fax Number:
320-597-8995
Provider Enumeration Date:
04/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOUREY
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
ANDREA
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
203-210-1663

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  003166 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 647220600 . This is a "MEDICAL ASSISTANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31G09SP . This is a "BLUE CROSS BLUE SHIELD GR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 350049912 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 411508205 . This is a "AETNA & SIGNA PREFERRED O" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1016069 . This is a "HEALTH SERVICE MANAGEMENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31G09SP . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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