MEDICARE: REGENTS MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363LA2200X	Adult Health Nurse Practitioner
2	363LF0000X	Family Nurse Practitioner
3	207R00000X	Internal Medicine Physician
4	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1922638881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENTS MEDICAL GROUP

Provider Business Mailing Address
First Line	:	254 REN MAR DR STE 100
Second Line	:
City	:	PLEASANT VIEW
State	:	TN
Zip	:	37146-3723
Country	:	US
Telephone Number	:	615-746-0203
Fax Number	:	615-746-0001

Provider Business Practice Location Address
First Line	:	254 REN MAR DR STE 100
Second Line	:
City	:	PLEASANT VIEW
State	:	TN
Zip	:	37146-3723
Country	:	US
Telephone Number	:	615-746-0203
Fax Number	:	615-746-0001

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LORI RAY
Credential	:
Telephone Number	:	615-746-0203

Provider Enumeration Date	:	01/20/2020
Last Update Date	:	01/20/2020

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