MEDICARE: NUTRIMED CLINICS 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	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1477834794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRIMED CLINICS LLC

Provider Business Mailing Address
First Line	:	5012 REMINGTON PARK DRIVE
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028
Country	:	US
Telephone Number	:	972-742-9863
Fax Number	:

Provider Business Practice Location Address
First Line	:	635 N ROBINSON DR
Second Line	:
City	:	ROBINSON
State	:	TX
Zip	:	76706-5330
Country	:	US
Telephone Number	:	254-662-2859
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. THOMAS MANNING NEALE II
Credential	:	RPH
Telephone Number	:	972-742-9863

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	08/31/2011

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