Healthcare Provider Details

I. General information

NPI: 1568151561
Provider Name (Legal Business Name): REGENERATIVE ORTHOPEDIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 SW WASHO CT STE 100
TUALATIN OR
97062-8342
US

IV. Provider business mailing address

7401 SW WASHO CT STE 100
TUALATIN OR
97062-8342
US

V. Phone/Fax

Practice location:
  • Phone: 503-905-4103
  • Fax: 503-656-9464
Mailing address:
  • Phone: 503-905-4103
  • Fax: 503-656-9464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY S FEINBLATT
Title or Position: MEMBER
Credential: MD
Phone: 503-905-4103