Provider Demographics
NPI:1760220842
Name:RENEWED LIFE MEDICAL GROUP PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:RENEWED LIFE MEDICAL GROUP PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-633-1441
Mailing Address - Street 1:376 HARTNELL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1881
Mailing Address - Country:US
Mailing Address - Phone:530-806-0404
Mailing Address - Fax:888-633-1441
Practice Address - Street 1:376 HARTNELL AVE STE A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1881
Practice Address - Country:US
Practice Address - Phone:530-806-0404
Practice Address - Fax:888-633-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty