Healthcare Provider Details

I. General information

NPI: 1730703547
Provider Name (Legal Business Name): AEGLE REGENIX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7242 TYLERS CORNER DR STE B
WEST CHESTER OH
45069-6335
US

IV. Provider business mailing address

7242 TYLERS CORNER DR STE B
WEST CHESTER OH
45069-6335
US

V. Phone/Fax

Practice location:
  • Phone: 513-644-9310
  • Fax:
Mailing address:
  • Phone: 513-644-9310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN M WEBSTER
Title or Position: OFFICE MANAGER
Credential: RN
Phone: 513-644-9310