Healthcare Provider Details

I. General information

NPI: 1083178255
Provider Name (Legal Business Name): RMD MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 05/31/2022
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 W COTTONWOOD LN STE 6
CASA GRANDE AZ
85122-2552
US

IV. Provider business mailing address

177 W COTTONWOOD LN STE 6
CASA GRANDE AZ
85122-2552
US

V. Phone/Fax

Practice location:
  • Phone: 520-233-5905
  • Fax: 520-233-5910
Mailing address:
  • Phone: 520-233-5905
  • Fax: 520-233-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY D WOOLEY
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 520-233-5905