1851762769 NPI number — RR MEDCO LLC

Table of content: (NPI 1851762769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851762769 NPI number — RR MEDCO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RR MEDCO LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851762769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E SAMPLE RD
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
POMPANO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33064-3554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
754-264-7540
Provider Business Mailing Address Fax Number:
754-222-9389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E SAMPLE RD STE 320
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMPANO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33064-3554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
754-264-7540
Provider Business Practice Location Address Fax Number:
754-222-9389
Provider Enumeration Date:
10/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DI IULIO
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
754-264-7540

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  ME53109 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2155098 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com