MEDICARE: REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1093532061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER

Provider Business Mailing Address
First Line	:	PO BOX 5158
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29304-5158
Country	:	US
Telephone Number	:	864-582-2411
Fax Number	:	864-582-7178

Provider Business Practice Location Address
First Line	:	220 IRBY ST
Second Line	:
City	:	WOODRUFF
State	:	SC
Zip	:	29388-1618
Country	:	US
Telephone Number	:	864-582-2411
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARLON HUNTER
Credential	:
Telephone Number	:	864-594-0190

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	09/23/2024

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