Provider Demographics
NPI:1215132782
Name:REDICLINIC, LLC
Entity type:Organization
Organization Name:REDICLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:FOURNET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-580-0455
Mailing Address - Street 1:NINE GREENWAY PLAZA
Mailing Address - Street 2:SUITE 2950
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0924
Mailing Address - Country:US
Mailing Address - Phone:866-607-7334
Mailing Address - Fax:713-358-4801
Practice Address - Street 1:NINE GREENWAY PLAZA
Practice Address - Street 2:SUITE 2950
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77046-0924
Practice Address - Country:US
Practice Address - Phone:866-607-7334
Practice Address - Fax:713-358-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y095Medicare PIN
OK600522427Medicare PIN
TX00Y412Medicare PIN
AR5F811Medicare PIN
VAC10279Medicare PIN