Provider Demographics
NPI:1124891635
Name:REGENERATIVE ORTHOPEDIC CENTER LLC
Entity type:Organization
Organization Name:REGENERATIVE ORTHOPEDIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-905-4102
Mailing Address - Street 1:7111 SW NYBERG ST
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-6245
Mailing Address - Country:US
Mailing Address - Phone:503-656-0836
Mailing Address - Fax:503-656-9464
Practice Address - Street 1:1508 DIVISION ST STE 105
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1584
Practice Address - Country:US
Practice Address - Phone:503-656-0836
Practice Address - Fax:503-656-9464
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENERATIVE ORTHOPEDIC CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty