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1730710369 NPI number — REGEN ORTHO SPINE & PAIN LLC

NPI Number: 1730710369
Health Care Provider/Practitioner: REGEN ORTHO SPINE & PAIN LLC

Information about “1730710369” NPI (REGEN ORTHO SPINE & PAIN LLC) exists in 1730710369 in HTML format HTML  |  1730710369 in plain Text format TXT  |  1730710369 in PDF (Portable Document Format) PDF  |  1730710369 in an XML format XML  formats.

NPI Number : 1730710369 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730710369",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "REGEN ORTHO SPINE & PAIN LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "407 MERAMEC BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EUREKA",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63025-3803",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "636-333-3700",
    "MailingAddressFaxNumber": "636-333-3701",
    "FirstLinePracticeLocationAddress": "407 MERAMEC BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EUREKA",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63025-3803",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "636-333-3700",
    "PracticeLocationAddressFaxNumber": "636-333-3701",
    "EnumerationDate": "02/02/2020",
    "LastUpdateDate": "01/13/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KUNHIRAMAN",
    "AuthorizedOfficialFirstName": "SAVITHA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OFFICE MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "636-333-9723",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208VP0014X",
        "TaxonomyName": "Interventional Pain Medicine Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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