MEDICARE: RANEK, LC

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	261QR0200X	Radiology Clinic/Center		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0433DC	OTHER	TX	BLUECROSS BLUESHIELD
2	P00249391	OTHER		RAILROAD MEICARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417912544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANEK, LC

Provider Business Mailing Address
First Line	:	PO BOX 632067
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75963-2067
Country	:	US
Telephone Number	:	936-462-9909
Fax Number	:	936-462-8528

Provider Business Practice Location Address
First Line	:	4932 NORTH ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1878
Country	:	US
Telephone Number	:	936-462-9909
Fax Number	:	936-462-8528

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MRS. KATHIE HALEY
Credential	:
Telephone Number	:	936-462-9909

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	05/12/2008

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Directions to “RANEK, LC ” Practice Location

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