Provider Demographics
NPI:1699789743
Name:REGENCY SQUARE EMERGENCY CARE P.A
Entity type:Organization
Organization Name:REGENCY SQUARE EMERGENCY CARE P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:LOEW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-288-4911
Mailing Address - Street 1:2520 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4533
Mailing Address - Country:US
Mailing Address - Phone:772-288-4911
Mailing Address - Fax:772-288-0691
Practice Address - Street 1:2520 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4533
Practice Address - Country:US
Practice Address - Phone:772-288-4911
Practice Address - Fax:772-288-0691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5429261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80527OtherBLUE CROSS AND BLUE SHIEL
FLD89611Medicare UPIN
FL33455Medicare PIN
FL33485Medicare ID - Type Unspecified