Provider Demographics
NPI:1376758391
Name:REDDIX FAMILY HEALTHCARE LLC
Entity Type:Organization
Organization Name:REDDIX FAMILY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDIX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-348-5622
Mailing Address - Street 1:9903 BRAEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-1505
Mailing Address - Country:US
Mailing Address - Phone:410-747-6040
Mailing Address - Fax:
Practice Address - Street 1:6819 REISTERSTOWN RD
Practice Address - Street 2:STE 103
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-1418
Practice Address - Country:US
Practice Address - Phone:410-585-0124
Practice Address - Fax:410-585-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-12
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty