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NPI Code Detail

MEDICARE: REDICLINIC US, LLC

MEDICARE: REDICLINIC US, 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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1427225705
Entity Type Code : Organization
Provider Name (Legal Business Name) : REDICLINIC US, LLC
Provider Business Mailing Address
First Line : 9 GREENWAY PLZ STE 2950
Second Line :
City : HOUSTON
State : TX
Zip : 77046-0924
Country : US
Telephone Number : 866-607-7334
Fax Number :
Provider Business Practice Location Address
First Line : 6360 LAKE WORTH BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76135-3604
Country : US
Telephone Number : 866-607-7334
Fax Number :
Authorized Official
Title or Position : COO
Name : RICK VANPELT
Credential :
Telephone Number : 713-580-0462
Provider Enumeration Date : 05/15/2008
Last Update Date : 05/15/2008

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Directions to “REDICLINIC US, LLC ” Practice Location

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