# REGEN 360 INDY LLC

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

## Provider details

- **NPI number:** 1851911945
- **Authorized official:** TORI LYNN MATTHEWS MA (MANAGER)
- **Authorized official phone:** (817) 915-9965

## Contact information

- **Practice address:** 70 E 91ST ST STE 101, INDIANAPOLIS, IN 46240-1550
- **Practice address phone:** (312) 972-8307
- **Mailing address:** 14251 LANGHAM DR, CARMEL, IN 46074-4401
- **Mailing address phone:** (312) 972-8307

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/20/2020
- **Last updated:** 04/20/2020