Provider Demographics
NPI:1295317618
Name:TOTAL REGENERATIVE SOLUTIONS
Entity type:Organization
Organization Name:TOTAL REGENERATIVE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING AND COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-632-6877
Mailing Address - Street 1:2101 PARKS AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4160
Mailing Address - Country:US
Mailing Address - Phone:818-424-4270
Mailing Address - Fax:
Practice Address - Street 1:2101 PARKS AVE STE 700
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4160
Practice Address - Country:US
Practice Address - Phone:818-424-4270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty