Provider Demographics
NPI:1598225278
Name:REGENERATIVE MEDICINE CENTER, PA
Entity Type:Organization
Organization Name:REGENERATIVE MEDICINE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-558-6700
Mailing Address - Street 1:4126 SOUTHWEST FWY STE 1130
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7317
Mailing Address - Country:US
Mailing Address - Phone:713-572-3888
Mailing Address - Fax:713-572-3880
Practice Address - Street 1:4126 SOUTHWEST FWY STE 1130
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7317
Practice Address - Country:US
Practice Address - Phone:713-572-3888
Practice Address - Fax:713-572-3880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty