Provider Demographics
NPI:1972349686
Name:REGENERATIVE MEDICAL AND WELLNESS CENTERS, LLC
Entity type:Organization
Organization Name:REGENERATIVE MEDICAL AND WELLNESS CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PORSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-320-3553
Mailing Address - Street 1:794 HIGHWAY 51 STE D
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9662
Mailing Address - Country:US
Mailing Address - Phone:601-572-5564
Mailing Address - Fax:
Practice Address - Street 1:794 HIGHWAY 51 STE D
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9662
Practice Address - Country:US
Practice Address - Phone:601-572-5564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center