Provider Demographics
NPI:1558962415
Name:REGENERATIVE MEDICINE OF KENTUCKY
Entity Type:Organization
Organization Name:REGENERATIVE MEDICINE OF KENTUCKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-425-6200
Mailing Address - Street 1:10900 ELECTRON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-3824
Mailing Address - Country:US
Mailing Address - Phone:502-425-6200
Mailing Address - Fax:502-425-6400
Practice Address - Street 1:10900 ELECTRON DR STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-3824
Practice Address - Country:US
Practice Address - Phone:502-425-6200
Practice Address - Fax:502-425-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty