Provider Demographics
NPI:1083130520
Name:REGENMD, LLC
Entity Type:Organization
Organization Name:REGENMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PIERRE
Authorized Official - Last Name:GIBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-801-4005
Mailing Address - Street 1:764 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7168
Mailing Address - Country:US
Mailing Address - Phone:843-405-1122
Mailing Address - Fax:843-225-4531
Practice Address - Street 1:764 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7168
Practice Address - Country:US
Practice Address - Phone:843-405-1122
Practice Address - Fax:843-225-4531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center