Provider Demographics
NPI:1144898123
Name:KANSAS REGENERATIVE MEDICINE CENTER
Entity type:Organization
Organization Name:KANSAS REGENERATIVE MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-320-4700
Mailing Address - Street 1:4809 VUE DU LAC PL STE 101
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-8678
Mailing Address - Country:US
Mailing Address - Phone:785-320-4700
Mailing Address - Fax:785-320-4704
Practice Address - Street 1:4809 VUE DU LAC PL STE 101
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-8678
Practice Address - Country:US
Practice Address - Phone:785-320-4700
Practice Address - Fax:785-320-4704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty