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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1194843714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDICLINIC LLC

Provider Business Mailing Address
First Line	:	9 GREENWAY PLAZA
Second Line	:	SUITE 2950
City	:	HOUSTON
State	:	TX
Zip	:	77046-0905
Country	:	US
Telephone Number	:	713-935-0333
Fax Number	:	713-358-4801

Provider Business Practice Location Address
First Line	:	1434 WELLS BRANCH PKWY
Second Line	:
City	:	PFLUGERVILLE
State	:	TX
Zip	:	78660-3153
Country	:	US
Telephone Number	:	713-935-0333
Fax Number	:	713-935-9353

Authorized Official
Title or Position	:	CFO
Name	:	ERIC P FOURNET
Credential	:
Telephone Number	:	713-580-9468

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	03/04/2009

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Directions to “REDICLINIC LLC ” Practice Location

Language	Start Address	Practice Location

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