Provider Demographics
NPI:1942650395
Name:REDICLINIC OF MD, LLC
Entity Type:Organization
Organization Name:REDICLINIC OF MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PAYER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PETTIGREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-335-1731
Mailing Address - Street 1:1230 BAY DALE DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2325
Mailing Address - Country:US
Mailing Address - Phone:713-335-1731
Mailing Address - Fax:713-358-4881
Practice Address - Street 1:9 GREENWAY PLZ
Practice Address - Street 2:SUITE 2950
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77046-0905
Practice Address - Country:US
Practice Address - Phone:713-335-1731
Practice Address - Fax:713-574-2794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center