Provider Demographics
NPI:1437539053
Name:REGENERATION CENTER
Entity type:Organization
Organization Name:REGENERATION CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:ME
Authorized Official - Phone:843-669-2882
Mailing Address - Street 1:1105 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-6605
Mailing Address - Country:US
Mailing Address - Phone:843-669-2882
Mailing Address - Fax:843-669-2882
Practice Address - Street 1:1801 JASON DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-3220
Practice Address - Country:US
Practice Address - Phone:843-669-2882
Practice Address - Fax:843-669-2882
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENERATION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100155546 SC3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport