Provider Demographics
NPI:1710469291
Name:PREMIER REGENERATIVE HEALTH, LLC
Entity Type:Organization
Organization Name:PREMIER REGENERATIVE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-613-2194
Mailing Address - Street 1:P.O. BOX 56555
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72215-6555
Mailing Address - Country:US
Mailing Address - Phone:469-933-3519
Mailing Address - Fax:501-232-2198
Practice Address - Street 1:1710 RUFE SNOW DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5501
Practice Address - Country:US
Practice Address - Phone:469-933-3519
Practice Address - Fax:501-232-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty