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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1447427232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDICLINIC US, LLC

Provider Business Mailing Address
First Line	:	9 GREENWAY PLZ
Second Line	:	SUITE 2950
City	:	HOUSTON
State	:	TX
Zip	:	77046-0905
Country	:	US
Telephone Number	:	866-607-7334
Fax Number	:	713-358-4801

Provider Business Practice Location Address
First Line	:	2635 PLEASANT HILL RD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-1450
Country	:	US
Telephone Number	:	866-607-7334
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. RICK VANPELT
Credential	:
Telephone Number	:	713-580-0462

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	05/12/2008

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Directions to “REDICLINIC US, LLC ” Practice Location

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