Coastal Regenex Ltd
Clinic/Center, Multi-Specialty in Chesapeake, VA. Organization (NPI-2).
NPI number1639705387
StatusActive
Last updated in NPPESMar 13, 2020
Details
- NPI
- 1639705387
- Entity type
- Organization (NPI-2)
- Legal business name
- Coastal Regenex Ltd
- Organization subpart
- No
- Enumeration date
- Mar 13, 2020
- Certification date
- Mar 13, 2020
- Last updated
- Mar 13, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM1300X | Clinic/Center, Multi-Specialty | – | – | Yes |
Practice location
1013 Eden Way N Ste BChesapeake, VA 23320-2792
Phone 757-297-6750 · Fax 757-609-3473
Mailing address
182 Odd RdPoquoson, VA 23662-2035
Phone 757-297-6750 · Fax 757-609-3473
Authorized official
Trey Williams
Owner
7572976750
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