Provider Demographics
NPI:1275408189
Name:REGENERATIVE ORTHOPEDIC CENTER LLC
Entity type:Organization
Organization Name:REGENERATIVE ORTHOPEDIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-905-4103
Mailing Address - Street 1:6485 SW BORLAND RD STE A
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9762
Mailing Address - Country:US
Mailing Address - Phone:503-656-0836
Mailing Address - Fax:503-656-9464
Practice Address - Street 1:6485 SW BORLAND RD STE A
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9762
Practice Address - Country:US
Practice Address - Phone:503-656-0836
Practice Address - Fax:503-656-9464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies