# RENEW MEDICAL SPA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ReNew Medical Spa and Nutritional Wellness Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164739025
- **Authorized official:** MRS. THERESA M FONTENOT PA-C (OWNER)
- **Authorized official phone:** (903) 255-6398

## Contact information

- **Practice address:** 3939 TEXAS BLVD, TEXARKANA, TX 75503-3207
- **Practice address phone:** (903) 255-6398
- **Practice address fax:** (903) 794-6304
- **Mailing address:** 3939 TEXAS BLVD, TEXARKANA, TX 75503-3207
- **Mailing address phone:** (903) 255-6398
- **Mailing address fax:** (903) 794-6304

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | PA-190 | AR | — |
| 261QM2500X | Medical Specialty Clinic/Center | PA00892 | TX | Yes |

## Other

- **Enumeration date:** 09/13/2010
- **Last updated:** 02/06/2012