Basic Information
| Provider Information | |||||||||
| NPI: | 1316072382 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REGEC | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2845 E HIGHWAY 76 | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | MULLINS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295746037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434312740 | ||||||||
| FaxNumber: | 8434312197 | ||||||||
| Practice Location | |||||||||
| Address1: | 2845 E HIGHWAY 76 | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | MULLINS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295746037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434312740 | ||||||||
| FaxNumber: | 8434312197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 02/09/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | TL29614 | SC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 296147 | 05 | SC | MEDICAID |