Healthcare Provider Details

I. General information

NPI: 1699122101
Provider Name (Legal Business Name): REGEN PAIN MANAGEMENT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 03/27/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 W PARKER RD STE 300
PLANO TX
75093-8177
US

IV. Provider business mailing address

6020 W PARKER RD STE 300
PLANO TX
75093-8177
US

V. Phone/Fax

Practice location:
  • Phone: 469-252-4777
  • Fax: 469-518-2156
Mailing address:
  • Phone: 469-252-4777
  • Fax: 469-518-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberQ0953
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JONATHAN C KONING
Title or Position: PRESIDENT
Credential: MD
Phone: 469-252-4777