Provider Demographics
NPI:1578744801
Name:REGENERATIVE MEDICINE CENTER, PLC
Entity Type:Organization
Organization Name:REGENERATIVE MEDICINE CENTER, PLC
Other - Org Name:PAIN MANAGEMENT CENTER OF VIRGINIA, PLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBRANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-709-6515
Mailing Address - Street 1:11800 SUNRISE VALLEY DRIVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5327
Mailing Address - Country:US
Mailing Address - Phone:703-709-1383
Mailing Address - Fax:703-709-6516
Practice Address - Street 1:11800 SUNRISE VALLEY DRIVE
Practice Address - Street 2:SUITE 500
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5327
Practice Address - Country:US
Practice Address - Phone:703-709-1383
Practice Address - Fax:703-709-6516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical