Regence Health Network Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Plainview, TX
NPI 1083613640 · NPPES record last updated May 9, 2024
Key facts
- NPI
- 1083613640
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 321756-01 (TX)
- Legal business name
- REGENCE HEALTH NETWORK INC
- Practice address
- 410 Canyon St
Plainview, TX 79072-7508 - Phone
- (806) 293-8561
- NPI assigned
- Jul 18, 2005
- Organization subpart
- No
Authorized official
- Name
- Rick C Love
- Title
- Ceo
- Phone
- (806) 293-8561
Owners & managing parties with NPI records 2
-
Robert Bidwell, M.D.
-
Perry Lee Collins, LPC
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 3
Practitioners 32
-
Robert Bidwell, M.D.
-
Cassondra Collins, LPC
-
Perry Lee Collins, LPC
-
Joseph Dad, LPC
-
Tanya Deleon, FNP
-
Cathi Lynne Eggart, FNP-C
-
Griselda Anna Garza, NP-C
-
Bradley H Hough, M.D.
-
Evelyn Veronica Iglesias, FNP-C
-
Morgan G Leak, M.D.
-
Angela Paulette Muniz, MSN-FNP
-
Jennifer Sepeda, FNP
-
Wilson Alan Cochrane, PA-C
-
Samuel L Jurado Jr., P.A.
-
Taylor Riggs, PA-C
-
Dori Lyn Wasmundt, PAC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D0506774 | Regence Health Network, Inc | Provider-performed microscopy | Mar 31, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Federally qualified health center certification: CCN 451859
- Legal name
- REGENCE HEALTH NETWORK INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 1, 1991
- Last certification
- Oct 1, 1991
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 15, 1973 in TX
- Enrollment address
- 410 Canyon St
Plainview, TX 79072-7508
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Rick Love |
Corporate Director |
Sep 6, 2006 | |
| Perry Lee Collins |
Corporate Director |
Oct 26, 2022 | |
| Sylvia Chavez |
Corporate Director |
Nov 30, 2022 | |
| Joe Alonzo |
Corporate Director | Oct 1, 2009 | |
| James Driskill |
Corporate Director |
Apr 1, 2023 | |
| Sean Wehrly |
Corporate Director |
Jul 25, 2013 | |
| Derek Martin |
Corporate Director |
Oct 1, 2009 | |
| Nancy Kernell |
Corporate Director |
Oct 26, 2022 | |
| Margaret Bell |
Corporate Director |
Mar 4, 2020 | |
| Michael Hemphill |
Corporate Director |
Oct 1, 2009 | |
| Robert Martinez |
Corporate Director |
Jun 1, 2013 | |
| Robert M Bidwell |
Operational/Managerial Control |
Oct 1, 2009 | |
| Verlene Dickson |
Corporate Director |
Dec 7, 2016 | |
| Gary Swann |
Corporate Director |
Oct 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040105000813 | TX | Part B Supplier - Clinic/Group Practice | 5698682557 |
Receives reassigned benefits from 32 practitioners 3 other NPIs on this enrollment Practice locations: Amarillo, TX; Plainview, TX; Hereford, TX |
| O20060926000598 | TX | Part a Provider - Federally Qualified Health Center (FQHC) | 5698682557 | Practice locations: Plainview, TX |
National Provider Directory
Locations
2601 Dimmitt Rd
#10110
Plainview, TX 79072
410 Canyon St
Plainview, TX 79072
Phone (806) 291-0297
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 321756-01 | TX | Yes |
Addresses
Primary practice location
410 Canyon St
Plainview, TX 79072-7508
Mailing address
2801 W 8TH St
Plainview, TX 79072-6737
Phone (806) 293-8561
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 135077903 | Medicaid | TX |
Other names
- South Plains Health Provider Organization, Inc.
Other providers in Plainview, TX
- Prairie Living Center, L.P.
- Premier Obstetrics & Gynecology, P.a.
- Noelia Quezada
- Radar Supports
- Ruth Kristine Rector-Wright
- Regence Health Network Inc
- Regence Health Network Inc
- Regence Health Network, Inc
- Regence Health Network, Inc.
- Joann Rey
All providers in Plainview, TX · Federally Qualified Health Center (FQHC) in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.