Provider Demographics
NPI:1124196670
Name:REDICLINIC LLC
Entity Type:Organization
Organization Name:REDICLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:VANPELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-935-0333
Mailing Address - Street 1:18059 CRESCENT ROYALE WAY
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3467
Mailing Address - Country:US
Mailing Address - Phone:866-935-0333
Mailing Address - Fax:713-935-9353
Practice Address - Street 1:2464 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4954
Practice Address - Country:US
Practice Address - Phone:713-580-0450
Practice Address - Fax:713-358-4845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center