Healthcare Provider Details

I. General information

NPI: 1982734273
Provider Name (Legal Business Name): RELIANCE MEDICAL CLINICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 SPAULDING AVE SPAULDING BUSINESS PARK
RICHLAND WA
99352
US

IV. Provider business mailing address

1445 SPAULDING PARK
RICHLAND WA
99352
US

V. Phone/Fax

Practice location:
  • Phone: 509-539-4273
  • Fax: 509-627-2090
Mailing address:
  • Phone: 509-420-0423
  • Fax: 509-420-0424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateWA

VIII. Authorized Official

Name: MR. KISHORE SHM VARADA
Title or Position: CHAIRMAN/OWNER
Credential: PA-C
Phone: 509-539-4273