Renew Medical Spa LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

PA00892 Issued in TX

Legal business name

RENEW MEDICAL SPA LLC

Practice address

3939 Texas Blvd
Texarkana, TX 75503-3207

Phone

(903) 255-6398

Fax

(903) 794-6304

NPI assigned

Sep 13, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Theresa M Fontenot, PA-C

Title

Owner

Phone

(903) 255-6398

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• ReNew Medical Spa and Nutritional Wellness Center Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328486400000",
    "number": "1164739025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3939 TEXAS BLVD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755033207",
            "telephone_number": "903-255-6398",
            "fax_number": "903-794-6304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3939 TEXAS BLVD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755033207",
            "telephone_number": "903-255-6398",
            "fax_number": "903-794-6304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW MEDICAL SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-13",
        "last_updated": "2012-02-06",
        "status": "A",
        "authorized_official_last_name": "FONTENOT",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-255-6398",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "TX",
            "license": "PA00892",
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "AR",
            "license": "PA-190",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA GOVERMENT SERVICES",
            "identifier": "4995690001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ReNew Medical Spa and Nutritional Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Samantha Reeder, PHARMD
• Wilmer Lynn Reep, MD
• Austin Reeves, D P M
• Reliant Medical LLC (Reliant Healthcare)
• Remnant of Hope Ministries
• Renew Wellness Services PLLC
• Respiratory Plus Inc
• Retreat Health Care Services Inc.
• Retreat Health Care Services Inc.
• Marion Arleen Reynolds, M.D.

• Medical Specialty Clinic/Center in Texarkana, TX
• Providers in Texarkana, TX by specialty
• Medical Specialty Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.