Healthcare Provider Details

I. General information

NPI: 1033749023
Provider Name (Legal Business Name): RUM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20325 N 51ST AVE STE 102
GLENDALE AZ
85308-5665
US

IV. Provider business mailing address

12409 W INDIAN SCHOOL RD STE B210
AVONDALE AZ
85392-9505
US

V. Phone/Fax

Practice location:
  • Phone: 480-930-4018
  • Fax:
Mailing address:
  • Phone: 623-935-9920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTY MORGAN
Title or Position: SOLE MEMBER
Credential: DC
Phone: 602-889-5833