Healthcare Provider Details

I. General information

NPI: 1770215329
Provider Name (Legal Business Name): REGENERATIVE MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 T RD
SEVERY KS
67137-4013
US

IV. Provider business mailing address

128 T RD
SEVERY KS
67137-4013
US

V. Phone/Fax

Practice location:
  • Phone: 620-845-4474
  • Fax:
Mailing address:
  • Phone: 620-845-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHAD MAY
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 620-845-4474