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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
1251K00000XPublic Health or Welfare Agency
2261QH0100XHealth Service Clinic/Center

General Provider Information

NPI Number : 1215132782
Entity Type Code : Organization
Provider Name (Legal Business Name) : REDICLINIC, LLC
Provider Business Mailing Address
First Line : NINE GREENWAY PLAZA
Second Line : SUITE 2950
City : HOUSTON
State : TX
Zip : 77046-0924
Country : US
Telephone Number : 866-607-7334
Fax Number : 713-358-4801
Provider Business Practice Location Address
First Line : NINE GREENWAY PLAZA
Second Line : SUITE 2950
City : HOUSTON
State : TX
Zip : 77046-0924
Country : US
Telephone Number : 866-607-7334
Fax Number : 713-358-4801
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : ERIC FOURNET
Credential :
Telephone Number : 713-580-0455
Provider Enumeration Date : 06/15/2007
Last Update Date : 01/08/2009

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