MEDICARE: REDICLINIC AUSTIN, 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	:	1912104910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDICLINIC AUSTIN, LLC

Provider Business Mailing Address
First Line	:	9 GREENWAY PLAZA
Second Line	:	SUITE 2950
City	:	HOUSTON
State	:	TX
Zip	:	77046-0905
Country	:	US
Telephone Number	:	866-935-0333
Fax Number	:	713-358-4801

Provider Business Practice Location Address
First Line	:	5401 SOUTH FM 1626
Second Line	:
City	:	KYLE
State	:	TX
Zip	:	78640
Country	:	US
Telephone Number	:	713-935-0333
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	DANIELLE BARRERA
Credential	:
Telephone Number	:	713-580-9489

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	06/05/2014

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