Healthcare Provider Details

I. General information

NPI: 1194718346
Provider Name (Legal Business Name): REGENTS MEDICAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 REN MAR DR SUITE 100
PLEASANT VIEW TN
37146-7107
US

IV. Provider business mailing address

254 REN MAR DR SUITE 100
PLEASANT VIEW TN
37146-7107
US

V. Phone/Fax

Practice location:
  • Phone: 615-746-0203
  • Fax: 615-746-0001
Mailing address:
  • Phone: 615-746-0203
  • Fax: 615-746-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORI A RAY
Title or Position: OWNER
Credential: MD
Phone: 615-746-0203