Provider Demographics
NPI:1952107278
Name:RE-GEN CONCIERGE OF TEXAS PLLC
Entity type:Organization
Organization Name:RE-GEN CONCIERGE OF TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTOREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-665-4539
Mailing Address - Street 1:5944 LUTHER LN STE 915
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5977
Mailing Address - Country:US
Mailing Address - Phone:803-665-4539
Mailing Address - Fax:
Practice Address - Street 1:5944 LUTHER LN STE 915
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5977
Practice Address - Country:US
Practice Address - Phone:803-665-4539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care