Provider Demographics
NPI:1891049979
Name:REGENERATION ORTHOPEDICS, LLC
Entity Type:Organization
Organization Name:REGENERATION ORTHOPEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-536-7000
Mailing Address - Street 1:6 MCBRIDE AND SON CENTER DR
Mailing Address - Street 2:STE 204
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1418
Mailing Address - Country:US
Mailing Address - Phone:636-536-7000
Mailing Address - Fax:636-898-5709
Practice Address - Street 1:12348 OLD TESSON RD
Practice Address - Street 2:STE120
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2251
Practice Address - Country:US
Practice Address - Phone:636-536-7000
Practice Address - Fax:636-898-5709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty