Provider Demographics
NPI:1699122101
Name:REGEN PAIN MANAGEMENT, PLLC
Entity type:Organization
Organization Name:REGEN PAIN MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:C
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:2016-05-16
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0953207LP2900X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty