Provider Demographics
NPI:1265668545
Name:REGENTS MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:REGENTS MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-746-0203
Mailing Address - Street 1:254 REN MAR DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-3722
Mailing Address - Country:US
Mailing Address - Phone:615-746-0203
Mailing Address - Fax:615-746-1460
Practice Address - Street 1:254 REN MAR DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-3722
Practice Address - Country:US
Practice Address - Phone:615-746-0203
Practice Address - Fax:615-746-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43129207Q00000X
TN35703207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty