Provider Demographics
NPI:1578689675
Name:RENAISSANCE CLINICAL RESEARCH & HYPERTENSION CLINIC OF TEXAS PLLC
Entity Type:Organization
Organization Name:RENAISSANCE CLINICAL RESEARCH & HYPERTENSION CLINIC OF TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYMON
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-638-1773
Mailing Address - Street 1:5959 HARRY HINES BLVD
Mailing Address - Street 2:SUITE 820
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6234
Mailing Address - Country:US
Mailing Address - Phone:214-638-1773
Mailing Address - Fax:
Practice Address - Street 1:5959 HARRY HINES BLVD
Practice Address - Street 2:SUITE 820
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6234
Practice Address - Country:US
Practice Address - Phone:214-638-1773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083741102Medicaid
TX083741102Medicaid