| Coastal Regenex Ltd | |
|
1013 Eden Way N Ste B Chesapeake VA 23320-2792 | |
| (757) 297-6750 | |
| (757) 609-3473 |
| Full Name | Coastal Regenex Ltd |
|---|---|
| Speciality | Clinic/Center |
| Location | 1013 Eden Way N Ste B, Chesapeake, Virginia |
| Authorized Official Name and Position | Trey Williams (OWNER) |
| Authorized Official Contact | 7572976750 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Regenex Ltd 182 Odd Rd Poquoson VA 23662-2035 Ph: (757) 297-6750 | Coastal Regenex Ltd 1013 Eden Way N Ste B Chesapeake VA 23320-2792 Ph: (757) 297-6750 |
| NPI Number | 1639705387 |
|---|---|
| Provider Enumeration Date | 03/13/2020 |
| Last Update Date | 03/13/2020 |
| Medicare PECOS PAC ID | 3173951241 |
|---|---|
| Medicare Enrollment ID | O20200615002416 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639705387 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Laura E Melsheimer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750928586 PECOS PAC ID: 1052732344 Enrollment ID: I20200521001532 |
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