Provider Demographics
NPI:1982734273
Name:RELIANCE MEDICAL CLINICS, PLLC
Entity Type:Organization
Organization Name:RELIANCE MEDICAL CLINICS, PLLC
Other - Org Name:SALUS HEALTH & NEUROPSYCH PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:SHM
Authorized Official - Last Name:VARADA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:509-539-4273
Mailing Address - Street 1:1445 SPAULDING PARK
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-420-0423
Mailing Address - Fax:509-420-0424
Practice Address - Street 1:1445 SPAULDING AVE
Practice Address - Street 2:SPAULDING BUSINESS PARK
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-539-4273
Practice Address - Fax:509-627-2090
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIANCE MEDICAL CLINICS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-06
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X, 261QR0405X, 324500000X, 363A00000X
207Q00000X, 207R00000X, 363A00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7139363Medicaid
WAG8867735Medicare PIN