Healthcare Provider Details

I. General information

NPI: 1699185405
Provider Name (Legal Business Name): REGENCY MEDICAL BRACING AND SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 PITTSBURGH ST SUITE 3B
UNIONTOWN PA
15401-2300
US

IV. Provider business mailing address

160 PITTSBURGH ST SUITE 3B
UNIONTOWN PA
15401-2300
US

V. Phone/Fax

Practice location:
  • Phone: 724-439-3338
  • Fax: 724-439-3337
Mailing address:
  • Phone: 724-439-3338
  • Fax: 724-439-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC005640
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM AINSLEY
Title or Position: D.P.M.
Credential: D.P.M.
Phone: 724-439-3338