Provider Demographics
NPI:1396431797
Name:REGAL HEALTHCARE, LLC
Entity type:Organization
Organization Name:REGAL HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MACKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-519-9810
Mailing Address - Street 1:17894 SW RICHARD CT
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-3913
Mailing Address - Country:US
Mailing Address - Phone:503-519-9810
Mailing Address - Fax:703-977-3863
Practice Address - Street 1:14125 SW FARMINGTON RD STE B
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2567
Practice Address - Country:US
Practice Address - Phone:503-519-9810
Practice Address - Fax:703-977-3863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty