Regeneration Nation LLC
Family Medicine in Tulsa, OK. Organization (NPI-2).
NPI number1164060158
StatusActive
Last updated in NPPESMar 26, 2024
Details
- NPI
- 1164060158
- Entity type
- Organization (NPI-2)
- Legal business name
- Regeneration Nation LLC
- Organization subpart
- No
- Enumeration date
- Dec 20, 2019
- Certification date
- Mar 26, 2024
- Last updated
- Mar 26, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
| 207K00000X | Allergy & Immunology | – | – |
Practice location
6565 S Yale Ave Ste 106Tulsa, OK 74136-8302
Phone 918-481-2772
Mailing address
6565 S Yale AveTulsa, OK 74136-8327
Authorized official
Brian Roadhouse
Owner, Authorized Official
9184812772
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