1518919612 NPI number — REGENESIS BIOMEDICAL, INC.

Table of content: (NPI 1518919612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518919612 NPI number — REGENESIS BIOMEDICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENESIS BIOMEDICAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518919612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5301 N. PIMA ROAD
Provider Second Line Business Mailing Address:
#150
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85250-2625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-970-4970
Provider Business Mailing Address Fax Number:
866-340-8328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5301 N. PIMA ROAD
Provider Second Line Business Practice Location Address:
#150
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85250-2625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-970-4970
Provider Business Practice Location Address Fax Number:
866-340-8328
Provider Enumeration Date:
05/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GENGE
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT-CFO
Authorized Official Telephone Number:
480-970-4970

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 81002228 . This is a "CCR-TPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 547490 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 609659800 . This is a "DOL" identifier . This identifiers is of the category "OTHER".