NPIMap

Organization Active NPI

Reliance International Clinic, LLC

  • Family Medicine Physician
  • Plano, TX
National Provider Identifier
1730699216
Registry record updated Oct 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RELIANCE INTERNATIONAL CLINIC, LLC
Practice address
4040 McDermott Rd Ste 100
Plano, TX 75024-7735
Phone
(469) 552-5988
Fax
(972) 668-1618
NPI assigned
Oct 10, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2017

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

Authorized official

Name
Jennifer Li
Title
Billing Manager
Phone
(469) 623-1816

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4040 McDermott Rd Ste 100
Plano, TX 75024-7735

Mailing address

4040 McDermott Rd Ste 100
Plano, TX 75024-7735
Phone (469) 552-5988

Other identifiers 1

IdentifierTypeStateIssuer
0391435-02MedicaidTX

Other names 1

  • Omni Medical Center Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1507593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507593600000",
    "number": "1730699216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4040 MCDERMOTT RD STE 100",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750247735",
            "telephone_number": "469-552-5988",
            "fax_number": "972-668-1618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4040 MCDERMOTT RD STE 100",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750247735",
            "telephone_number": "469-552-5988",
            "fax_number": "972-668-1618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RELIANCE INTERNATIONAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-10",
        "last_updated": "2017-10-10",
        "status": "A",
        "authorized_official_last_name": "LI",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "469-623-1816"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0391435-02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Omni Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plano, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2017; 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.