Provider Demographics
NPI:1083057376
Name:RELIANT TRANSITIONAL CARE LLC
Entity Type:Organization
Organization Name:RELIANT TRANSITIONAL CARE LLC
Other - Org Name:RELIANT MEDICAL MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-571-6050
Mailing Address - Street 1:5212 VILLAGE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5066
Mailing Address - Country:US
Mailing Address - Phone:972-447-9800
Mailing Address - Fax:
Practice Address - Street 1:5212 VILLAGE CREEK DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5066
Practice Address - Country:US
Practice Address - Phone:972-447-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty