Healthcare Provider Details

I. General information

NPI: 1104093673
Provider Name (Legal Business Name): REDICLINIC US, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 HICKORY CREEK BLVD
HICKORY CREEK TX
75065-7552
US

IV. Provider business mailing address

9 GREENWAY PLZ STE 2950
HOUSTON TX
77046-0924
US

V. Phone/Fax

Practice location:
  • Phone: 866-607-7334
  • Fax:
Mailing address:
  • Phone: 866-607-7334
  • Fax: 713-358-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICK VANPELT
Title or Position: COO
Credential:
Phone: 713-580-0462