Provider Demographics
NPI:1104481233
Name:REGEN PAIN MANAGEMENT, PLLC
Entity type:Organization
Organization Name:REGEN PAIN MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:KONING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-252-4777
Mailing Address - Street 1:6020 W PARKER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8177
Mailing Address - Country:US
Mailing Address - Phone:469-252-4777
Mailing Address - Fax:469-518-2156
Practice Address - Street 1:6020 W PARKER RD STE 300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8177
Practice Address - Country:US
Practice Address - Phone:469-252-4777
Practice Address - Fax:469-518-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies