Provider Demographics
NPI:1760684203
Name:RICHARD D REDINGTON MD ASSOCIATED FAMILY PRACTICE ASSOCIATION
Entity Type:Organization
Organization Name:RICHARD D REDINGTON MD ASSOCIATED FAMILY PRACTICE ASSOCIATION
Other - Org Name:FAMILY PRACTICE ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DANA
Authorized Official - Last Name:REDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-937-1210
Mailing Address - Street 1:1410 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2232
Mailing Address - Country:US
Mailing Address - Phone:972-937-1210
Mailing Address - Fax:972-937-0243
Practice Address - Street 1:1410 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2232
Practice Address - Country:US
Practice Address - Phone:972-937-1210
Practice Address - Fax:972-937-0243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112140201Medicaid
TXB25831Medicare UPIN
TX00E765Medicare PIN