Provider Demographics
NPI:1043800345
Name:RENEW MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:RENEW MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-842-1261
Mailing Address - Street 1:17250 N 43RD AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4037
Mailing Address - Country:US
Mailing Address - Phone:623-842-1261
Mailing Address - Fax:623-334-0182
Practice Address - Street 1:17250 N 43RD AVE STE 5
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-4037
Practice Address - Country:US
Practice Address - Phone:623-842-1261
Practice Address - Fax:623-334-0182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty