Provider Demographics
NPI:1932284502
Name:RENAISSANCE CLINICAL RESEARCH
Entity Type:Organization
Organization Name:RENAISSANCE CLINICAL RESEARCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYMON
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-638-1773
Mailing Address - Street 1:5959 HARRY HINES BLVD STE 820
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6233
Mailing Address - Country:US
Mailing Address - Phone:214-638-1773
Mailing Address - Fax:
Practice Address - Street 1:5959 HARRY HINES BLVD STE 820
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6233
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:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0896174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S7400OtherBC/BS
TX00535ZMedicare ID - Type Unspecified
TX8S7400OtherBC/BS