Healthcare Provider Details

I. General information

NPI: 1205408564
Provider Name (Legal Business Name): RENEWED HEALTH CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 S JEFFERSON AVE
MT PLEASANT TX
75455-5355
US

IV. Provider business mailing address

1318 S JEFFERSON AVE
MT PLEASANT TX
75455-5355
US

V. Phone/Fax

Practice location:
  • Phone: 903-572-1128
  • Fax: 903-572-1138
Mailing address:
  • Phone: 903-572-1128
  • Fax: 903-572-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. COURTNEY M DURRUM
Title or Position: OWNER
Credential: DC
Phone: 903-572-1128