Provider Demographics
NPI:1457101206
Name:REGEN HEALTH TEXAS, PLLC
Entity Type:Organization
Organization Name:REGEN HEALTH TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SERNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-313-5597
Mailing Address - Street 1:6001 HARRIS PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4103
Mailing Address - Country:US
Mailing Address - Phone:817-313-5597
Mailing Address - Fax:817-370-6401
Practice Address - Street 1:6001 HARRIS PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4103
Practice Address - Country:US
Practice Address - Phone:817-313-5597
Practice Address - Fax:817-370-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty