Healthcare Provider Details

I. General information

NPI: 1255598538
Provider Name (Legal Business Name): RM MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11912 KANIS RD STE F-8
LITTLE ROCK AR
72211-3733
US

IV. Provider business mailing address

11912 KANIS RD STE F-8
LITTLE ROCK AR
72211-3733
US

V. Phone/Fax

Practice location:
  • Phone: 501-255-1580
  • Fax: 501-255-1585
Mailing address:
  • Phone: 501-255-1580
  • Fax: 501-255-1585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateAR

VIII. Authorized Official

Name: ROBERT MAZZARELLA
Title or Position: PRESIDENT
Credential:
Phone: 501-255-1580