Healthcare Provider Details

I. General information

NPI: 1982110284
Provider Name (Legal Business Name): REGENERATIVE MEDICAL INSTITUTE FOR PAIN & NEUROPATHY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 DATA DR STE 1
HOOVER AL
35244
US

IV. Provider business mailing address

1849 DATA DR STE 1
HOOVER AL
35244-1202
US

V. Phone/Fax

Practice location:
  • Phone: 205-774-8222
  • Fax: 205-319-4899
Mailing address:
  • Phone: 205-774-8222
  • Fax: 205-319-4899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number30056
License Number StateAL

VIII. Authorized Official

Name: DR. SHAUNDA ELYSE KELLY
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 205-774-8222