MEDICARE: RICHMOND CLINIC, 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	207R00000X	Internal Medicine Physician	K0150	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K0150	OTHER		TEXAS MEDICAL BOARD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245312065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHMOND CLINIC, LLC

Provider Business Mailing Address
First Line	:	6550 MAPLERIDGE ST STE 218
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4647
Country	:	US
Telephone Number	:	713-344-1557
Fax Number	:	713-344-0434

Provider Business Practice Location Address
First Line	:	6550 MAPLERIDGE ST STE 218
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4647
Country	:	US
Telephone Number	:	713-344-1557
Fax Number	:	713-344-0434

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. AUSTIN ORETTE
Credential	:	M.D.
Telephone Number	:	713-344-1557

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	10/24/2007

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