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General NPI Number Information
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NPI Number | 1841508967
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Entity Type | Organization
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Legal Business Name | REDICLINIC AUSTIN, LLC
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 6900 BRODIE LN
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City | AUSTIN
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State | TX
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Zip | 78745-5008
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Country | US
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Telephone | 512-892-2300
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Fax | 512-892-2302
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Provider Business Mailing Address
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Address Line | 9 GREENWAY PLZ STE. 2950
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City | HOUSTON
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State | TX
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Zip | 77046-0905
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MS. DANIELLE BARRERA
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Credential |
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Telephone | 713-580-9489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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