Healthcare Provider Details

I. General information

NPI: 1144898123
Provider Name (Legal Business Name): KANSAS REGENERATIVE MEDICINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 VUE DU LAC PL STE 101
MANHATTAN KS
66503-8678
US

IV. Provider business mailing address

4809 VUE DU LAC PL STE 101
MANHATTAN KS
66503-8678
US

V. Phone/Fax

Practice location:
  • Phone: 785-320-4700
  • Fax: 785-320-4704
Mailing address:
  • Phone: 785-320-4700
  • Fax: 785-320-4704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KEN WOODS
Title or Position: CEO
Credential:
Phone: 785-320-4700