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RENEW MEDICAL SPA LLC NPI 1164739025


NPI Information

NPI: 1164739025
Provider Name: RENEW MEDICAL SPA LLC

Other Name: RENEW MEDICAL SPA AND NUTRITIONAL WELLNESS CENTER

Classification: Clinic/Center - 261QM2500X
Entity Type: Organization

Specialization: Medical Specialty

Address:
3939 TEXAS BLVD
TEXARKANA, TX
ZIP 75503
Phone: (903) 255-6398
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RENEW MEDICAL SPA LLC is a medical specialty clinic center in Texarkana, TX. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). RENEW MEDICAL SPA LLC NPI is 1164739025. The provider is registered as an organization entity type.
The provider Other Name Is Renew Medical Spa And Nutritional Wellness Center.

The provider's business location address is:

3939 TEXAS BLVD
TEXARKANA, TX
ZIP 75503-207
Phone: (903) 255-6398
Fax: (903) 794-6304

The provider's authorized official is Theresa M Fontenot .
The authorized official title is Owner and has the following contact phone number (903) 255-6398.

The enumeration date for this NPI number is 9/13/2010 and was last updated on 2/6/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM2500XClinic/CenterMedical SpecialtyPA-190ARKANSASNo
2261QM2500XClinic/CenterMedical SpecialtyPA00892TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1R64719MEDICARE UPIN
24995690001OTHERTEXASCIGNA GOVERMENT SERVICES
38B4007MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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