| Regenerative Physical Medicine Llc | |
|
250 Pierce St Ste 103 Kingston PA 18704-5149 | |
| (570) 287-1110 | |
| (570) 287-1121 |
| Full Name | Regenerative Physical Medicine Llc |
|---|---|
| Speciality | General Practice |
| Location | 250 Pierce St Ste 103, Kingston, Pennsylvania |
| Authorized Official Name and Position | Tracy H Underdown (OWNER) |
| Authorized Official Contact | 5707725362 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Regenerative Physical Medicine Llc 1111 E 3rd St Williamsport PA 17701-5411 Ph: (570) 772-5362 | Regenerative Physical Medicine Llc 250 Pierce St Ste 103 Kingston PA 18704-5149 Ph: (570) 287-1110 |
| NPI Number | 1942923693 |
|---|---|
| Provider Enumeration Date | 09/19/2022 |
| Last Update Date | 09/19/2022 |
| Medicare PECOS PAC ID | 7810367851 |
|---|---|
| Medicare Enrollment ID | O20230107000010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942923693 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Stephanie Lilly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285101592 PECOS PAC ID: 4385981950 Enrollment ID: I20190122000938 |
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