Provider Demographics
NPI:1669827614
Name:REGENIREX, LLC
Entity Type:Organization
Organization Name:REGENIREX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BURT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCKEAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-224-3723
Mailing Address - Street 1:4620 DOVE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-0639
Mailing Address - Country:US
Mailing Address - Phone:308-224-3723
Mailing Address - Fax:
Practice Address - Street 1:5205 2ND AVE STE 1
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2471
Practice Address - Country:US
Practice Address - Phone:308-237-9696
Practice Address - Fax:308-237-4517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22010207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025124701Medicaid