Provider Demographics
NPI:1285186999
Name:REGENT BUNDLE OF RENO
Entity Type:Organization
Organization Name:REGENT BUNDLE OF RENO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-492-0531
Mailing Address - Street 1:4 WESTBROOK CORP CTR
Mailing Address - Street 2:SUITE 440
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5752
Mailing Address - Country:US
Mailing Address - Phone:708-492-0531
Mailing Address - Fax:
Practice Address - Street 1:4 WESTBROOK CORP CTR
Practice Address - Street 2:SUITE 440
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5752
Practice Address - Country:US
Practice Address - Phone:708-492-0531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical