MEDICARE: CLARITYMD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	R17143	TX

General Provider Information

NPI Number	:	1497912109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARITYMD, LLC

Provider Business Mailing Address
First Line	:	3104 LATING STREAM LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-2004
Country	:	US
Telephone Number	:	512-826-1245
Fax Number	:

Provider Business Practice Location Address
First Line	:	3104 LATING STREAM LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-2004
Country	:	US
Telephone Number	:	512-826-1245
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOHN PAUL RELIC
Credential	:
Telephone Number	:	512-826-1245

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	04/30/2010

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