Provider Demographics
NPI:1194843748
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:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN PELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-935-0333
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 1:7405 FM 1960 RD E
Practice Address - Street 2:
Practice Address - City:ATASCOCITA
Practice Address - State:TX
Practice Address - Zip Code:77346-3128
Practice Address - Country:US
Practice Address - Phone:866-935-0333
Practice Address - Fax:713-935-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center