Regen 360 Indy LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

REGEN 360 INDY LLC

Practice address

70 E 91St St Ste 101
Indianapolis, IN 46240-1550

Phone

(312) 972-8307

NPI assigned

Apr 20, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tori Lynn Matthews, MA

Title

Manager

Phone

(817) 915-9965

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587340800000",
    "number": "1851911945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14251 LANGHAM DR",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460744401",
            "telephone_number": "312-972-8307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 E 91ST ST STE 101",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462401550",
            "telephone_number": "312-972-8307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGEN 360 INDY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-20",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A",
        "authorized_official_last_name": "MATTHEWS",
        "authorized_official_first_name": "TORI",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "817-915-9965",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.