Provider Demographics
NPI:1922641406
Name:REGENERATIVE MEDICINE OF SOUTH ALABAMA LLC
Entity Type:Organization
Organization Name:REGENERATIVE MEDICINE OF SOUTH ALABAMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-490-3235
Mailing Address - Street 1:3929 AIRPORT BLVD STE 3-110
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-2234
Mailing Address - Country:US
Mailing Address - Phone:251-307-1855
Mailing Address - Fax:251-301-0870
Practice Address - Street 1:3929 AIRPORT BLVD STE 3-110
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2234
Practice Address - Country:US
Practice Address - Phone:251-307-1855
Practice Address - Fax:251-301-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service