Provider Demographics
NPI:1417314857
Name:REGENEXX KC
Entity Type:Organization
Organization Name:REGENEXX KC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-974-7487
Mailing Address - Street 1:6151 THORNTON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321-2413
Mailing Address - Country:US
Mailing Address - Phone:515-422-7458
Mailing Address - Fax:
Practice Address - Street 1:1300 E 104TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4510
Practice Address - Country:US
Practice Address - Phone:855-550-9906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARBORVIEW HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-15
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty