Provider Demographics
NPI:1730710369
Name:REGEN ORTHO SPINE & PAIN LLC
Entity type:Organization
Organization Name:REGEN ORTHO SPINE & PAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAVITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNHIRAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-333-9723
Mailing Address - Street 1:407 MERAMEC BLVD
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-3803
Mailing Address - Country:US
Mailing Address - Phone:636-333-3700
Mailing Address - Fax:636-333-3701
Practice Address - Street 1:407 MERAMEC BLVD
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3803
Practice Address - Country:US
Practice Address - Phone:636-333-3700
Practice Address - Fax:636-333-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-02
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty