Provider Demographics
NPI:1750732343
Name:SEDONA REGENERATIVE MEDICINE, PC
Entity type:Organization
Organization Name:SEDONA REGENERATIVE MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:D
Authorized Official - Last Name:LANCHBURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-282-2520
Mailing Address - Street 1:708 COVE PKWY
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-5332
Mailing Address - Country:US
Mailing Address - Phone:928-282-2520
Mailing Address - Fax:928-433-4985
Practice Address - Street 1:708 COVE PKWY
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-5332
Practice Address - Country:US
Practice Address - Phone:928-282-2520
Practice Address - Fax:928-433-4985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-25
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50515208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG62555Medicare UPIN