Rediclinic of PA, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

REDICLINIC OF PA, LLC

Practice address

169 W Lancaster Ave
Ardmore, PA 19003-1401

Phone

(713) 335-1754

Fax

(713) 358-4870

NPI assigned

Sep 18, 2014

Organization subpart

No

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

Authorized official

Name

Danielle Barrera

Title

Chief Operating Officer

Phone

(713) 580-9489

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410998400000",
    "number": "1285036418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 GREENWAY PLZ",
            "address_2": "STE. 2950",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770460905",
            "telephone_number": "713-335-1754",
            "fax_number": "713-358-4870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 W LANCASTER AVE",
            "city": "ARDMORE",
            "state": "PA",
            "postal_code": "190031401",
            "telephone_number": "713-335-1754",
            "fax_number": "713-358-4870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDICLINIC OF PA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-18",
        "last_updated": "2014-09-18",
        "status": "A",
        "authorized_official_last_name": "BARRERA",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "713-580-9489"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Ardmore, PA
• Providers in Ardmore, PA by specialty
• Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; 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.