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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 : 1144538265
Entity Type Code : Organization
Provider Name (Legal Business Name) : REDICLINIC, LLC
Provider Business Mailing Address
First Line : 9 GREENWAY PLZ
Second Line : STE. 2950
City : HOUSTON
State : TX
Zip : 77046-0905
Country : US
Telephone Number : 713-335-1754
Fax Number : 713-358-4870
Provider Business Practice Location Address
First Line : 8503 NW MILITARY HWY
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78231-1841
Country : US
Telephone Number : 210-492-8200
Fax Number : 210-492-8201
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : MS. DANIELLE BARRERA
Credential :
Telephone Number : 713-580-9489
Provider Enumeration Date : 09/23/2010
Last Update Date : 06/30/2011

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Directions to “REDICLINIC, LLC ” Practice Location

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