Provider Demographics
NPI:1477834794
Name:NUTRIMED CLINICS LLC
Entity Type:Organization
Organization Name:NUTRIMED CLINICS LLC
Other - Org Name:ROBINSON COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MANNING
Authorized Official - Last Name:NEALE
Authorized Official - Suffix:II
Authorized Official - Credentials:RPH
Authorized Official - Phone:972-742-9863
Mailing Address - Street 1:5012 REMINGTON PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028
Mailing Address - Country:US
Mailing Address - Phone:972-742-9863
Mailing Address - Fax:
Practice Address - Street 1:635 N ROBINSON DR
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:TX
Practice Address - Zip Code:76706-5330
Practice Address - Country:US
Practice Address - Phone:254-662-2859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health