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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 : 1033287651
Entity Type Code : Organization
Provider Name (Legal Business Name) : REDICLINIC LLC
Provider Business Mailing Address
First Line : 9 GREENWAY PLZ
Second Line : SUITE 2950
City : HOUSTON
State : TX
Zip : 77046-0905
Country : US
Telephone Number : 866-935-0333
Fax Number :
Provider Business Practice Location Address
First Line : 5230 DALLAS HWY
Second Line :
City : POWDER SPRINGS
State : GA
Zip : 30127-4263
Country : US
Telephone Number : 713-935-0333
Fax Number :
Authorized Official
Title or Position : COO
Name : RICK VANPELT
Credential :
Telephone Number : 866-935-0333
Provider Enumeration Date : 12/01/2006
Last Update Date : 03/04/2008

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Directions to “REDICLINIC LLC ” Practice Location

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