Provider Demographics
NPI:1518919612
Name:REGENESIS BIOMEDICAL, INC.
Entity Type:Organization
Organization Name:REGENESIS BIOMEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT-CFO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GENGE
Authorized Official - Suffix:
Authorized Official - Credentials:VP CFO
Authorized Official - Phone:480-970-4970
Mailing Address - Street 1:5301 N. PIMA ROAD
Mailing Address - Street 2:#150
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-2625
Mailing Address - Country:US
Mailing Address - Phone:480-970-4970
Mailing Address - Fax:866-340-8328
Practice Address - Street 1:5301 N. PIMA ROAD
Practice Address - Street 2:#150
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-2625
Practice Address - Country:US
Practice Address - Phone:480-970-4970
Practice Address - Fax:866-340-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
81002228OtherCCR-TPIN
AZ547490Medicaid
609659800OtherDOL
AZ547490Medicaid