Provider Demographics
NPI:1801330295
Name:CLP REGENCY OF TEXAS, LLC
Entity type:Organization
Organization Name:CLP REGENCY OF TEXAS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP, CHIEF LEGAL OFFICER & CORPORAT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:G
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-309-5668
Mailing Address - Street 1:10 CADILLAC DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1001
Mailing Address - Country:US
Mailing Address - Phone:615-377-7022
Mailing Address - Fax:615-373-4457
Practice Address - Street 1:1523 NORMAL PARK DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340
Practice Address - Country:US
Practice Address - Phone:936-755-3108
Practice Address - Fax:866-955-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty