Provider Demographics
NPI:1770215329
Name:REGENERATIVE MEDICAL, LLC
Entity Type:Organization
Organization Name:REGENERATIVE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-845-4474
Mailing Address - Street 1:128 T RD
Mailing Address - Street 2:
Mailing Address - City:SEVERY
Mailing Address - State:KS
Mailing Address - Zip Code:67137-4013
Mailing Address - Country:US
Mailing Address - Phone:620-845-4474
Mailing Address - Fax:
Practice Address - Street 1:128 T RD
Practice Address - Street 2:
Practice Address - City:SEVERY
Practice Address - State:KS
Practice Address - Zip Code:67137-4013
Practice Address - Country:US
Practice Address - Phone:620-845-4474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy