Regenerative Physical Medicine LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

REGENERATIVE PHYSICAL MEDICINE LLC

Practice address

250 Pierce St Ste 103
Kingston, PA 18704-5149

Phone

(570) 287-1110

Fax

(570) 287-1121

NPI assigned

Sep 19, 2022

Organization subpart

No

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

Authorized official

Name

Tracy H Underdown, SOLE MBR

Title

Owner

Phone

(570) 772-5362

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1663545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663545600000",
    "number": "1942923693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 E 3RD ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177015411",
            "telephone_number": "570-772-5362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 PIERCE ST STE 103",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187045149",
            "telephone_number": "570-287-1110",
            "fax_number": "570-287-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENERATIVE PHYSICAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-19",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A",
        "authorized_official_last_name": "UNDERDOWN",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-772-5362",
        "authorized_official_credential": "SOLE MBR"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Kingston, PA
• Providers in Kingston, PA by specialty
• General Practice Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; 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.