Provider Demographics
NPI:1477955672
Name:RENEW CLINIC LLC
Entity Type:Organization
Organization Name:RENEW CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-501-1999
Mailing Address - Street 1:6060 BELLAIRE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5425
Mailing Address - Country:US
Mailing Address - Phone:281-501-1999
Mailing Address - Fax:281-501-8543
Practice Address - Street 1:6060 BELLAIRE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5425
Practice Address - Country:US
Practice Address - Phone:281-501-1999
Practice Address - Fax:281-501-8543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty