Healthcare Provider Details

I. General information

NPI: 1699789743
Provider Name (Legal Business Name): REGENCY SQUARE EMERGENCY CARE P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 SE FEDERAL HWY
STUART FL
34994-4533
US

IV. Provider business mailing address

2520 SE FEDERAL HWY
STUART FL
34994-4533
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-4911
  • Fax: 772-288-0691
Mailing address:
  • Phone: 772-288-4911
  • Fax: 772-288-0691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License NumberOS5429
License Number StateFL

VIII. Authorized Official

Name: DR. RICHARD DOUGLAS LOEW
Title or Position: PRESIDENT/OWNER
Credential: D.O.
Phone: 772-288-4911