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NPI Code Detail

MEDICARE: REDICLINIC LLC

MEDICARE: REDICLINIC 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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1841339454
Entity Type Code : Organization
Provider Name (Legal Business Name) : REDICLINIC LLC
Provider Business Mailing Address
First Line : 9 GREENWAY PLAZA
Second Line : SUITE 2950
City : HOUSTON
State : TX
Zip : 77046-0905
Country : US
Telephone Number : 866-935-0333
Fax Number : 713-358-4801
Provider Business Practice Location Address
First Line : 12000 IRON BRIDGE RD
Second Line :
City : CHESTER
State : VA
Zip : 23831-1459
Country : US
Telephone Number : 866-935-0333
Fax Number : 713-935-9353
Authorized Official
Title or Position : CFO
Name : ERIC P FOURNET
Credential :
Telephone Number : 713-580-9468
Provider Enumeration Date : 02/06/2007
Last Update Date : 01/20/2009

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Directions to “REDICLINIC LLC ” Practice Location

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