MEDICARE: REDIMD, 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1366684102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDIMD, LLC

Provider Business Mailing Address
First Line	:	PO BOX 569
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77497-0569
Country	:	US
Telephone Number	:	866-989-2873
Fax Number	:	713-481-0260

Provider Business Practice Location Address
First Line	:	117 LANE DR
Second Line	:	SUITE 2
City	:	ROSENBERG
State	:	TX
Zip	:	77471-2200
Country	:	US
Telephone Number	:	866-989-2873
Fax Number	:	713-481-0260

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. RACHEL J ZETINO
Credential	:
Telephone Number	:	866-989-2873

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	03/25/2009

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Directions to “REDIMD, LLC ” Practice Location

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