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General NPI Number Information
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NPI Number | 1730710369
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Entity Type | Organization
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Legal Business Name | REGEN ORTHO SPINE & PAIN LLC
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Dates
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Enumeration Date | 02/02/2020
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 407 MERAMEC BLVD
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City | EUREKA
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State | MO
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Zip | 63025-3803
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Country | US
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Telephone | 636-333-3700
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Fax | 636-333-3701
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Provider Business Mailing Address
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Address Line | 407 MERAMEC BLVD
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City | EUREKA
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State | MO
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Zip | 63025-3803
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Country | US
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Telephone | 636-333-3700
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Fax | 636-333-3701
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SAVITHA KUNHIRAMAN
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Credential |
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Telephone | 636-333-9723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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