Healthcare Provider Details

I. General information

NPI: 1043237886
Provider Name (Legal Business Name): RIM COUNTRY SPORTS MEDICINE AND ORTHOPEDIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E MAIN ST SUITE A
PAYSON AZ
85541-5488
US

IV. Provider business mailing address

PO BOX 2051
PAYSON AZ
85547-2051
US

V. Phone/Fax

Practice location:
  • Phone: 928-472-2900
  • Fax:
Mailing address:
  • Phone: 928-634-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4121
License Number StateAZ

VIII. Authorized Official

Name: OLIVIA E. MORRIS
Title or Position: OWNER
Credential: DO
Phone: 928-472-2900