Provider Demographics
NPI:1245775303
Name:REGENCE HEALTH NETWORK, INC
Entity Type:Organization
Organization Name:REGENCE HEALTH NETWORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:806-293-8561
Mailing Address - Street 1:3423 S SONCY RD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6400
Mailing Address - Country:US
Mailing Address - Phone:806-374-7341
Mailing Address - Fax:
Practice Address - Street 1:715 AMARILLO ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-6743
Practice Address - Country:US
Practice Address - Phone:806-293-8561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENCE HEALTH NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty