Healthcare Provider Details

I. General information

NPI: 1669827614
Provider Name (Legal Business Name): REGENIREX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 2ND AVE STE 1
KEARNEY NE
68847-2471
US

IV. Provider business mailing address

4620 DOVE HILL AVE
KEARNEY NE
68845-0639
US

V. Phone/Fax

Practice location:
  • Phone: 308-237-9696
  • Fax: 308-237-4517
Mailing address:
  • Phone: 308-224-3723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number22010
License Number StateNE

VIII. Authorized Official

Name: DR. BURT J. MCKEAG
Title or Position: OWNER
Credential: M.D.
Phone: 308-224-3723