# OSTEOPATHIC REGENERATIVE MEDICINE CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629564463
- **Authorized official:** KRISTOPHER GODDARD DO (OWNDER)
- **Authorized official phone:** (305) 367-1176

## Contact information

- **Practice address:** 3915 BISCAYNE BLVD STE 406, MIAMI, FL 33137-3737
- **Practice address phone:** (305) 367-1176
- **Practice address fax:** (877) 391-1611
- **Mailing address:** 3915 BISCAYNE BLVD STE 406, MIAMI, FL 33137-3737
- **Mailing address phone:** (305) 367-1176
- **Mailing address fax:** (877) 391-1611

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | OS10979 | FL | Yes |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | OS10979 | FL | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | OS10979 | FL | — |
| 2083S0010X | Sports Medicine (Preventive Medicine) Physician | OS10979 | FL | — |
| 2085U0001X | Diagnostic Ultrasound Physician | OS10979 | FL | — |
| 208VP0000X | Pain Medicine Physician | OS10979 | FL | — |
| 208VP0014X | Interventional Pain Medicine Physician | OS10979 | FL | — |
| 213EP1101X | Primary Podiatric Medicine Podiatrist | — | FL | — |
| 213ER0200X | Radiology Podiatrist | — | FL | — |
| 213ES0000X | Sports Medicine Podiatrist | — | FL | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | FL | — |

## Other

- **Enumeration date:** 07/05/2018
- **Last updated:** 07/05/2018