Healthcare Provider Details

I. General information

NPI: 1467427617
Provider Name (Legal Business Name): RICHARD V RIMKUS PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8144 E CACTUS RD SUITE 800
SCOTTSDALE AZ
85260-5266
US

IV. Provider business mailing address

8144 E CACTUS RD SUITE 800
SCOTTSDALE AZ
85260-5266
US

V. Phone/Fax

Practice location:
  • Phone: 480-596-8525
  • Fax: 480-596-8522
Mailing address:
  • Phone: 480-596-8525
  • Fax: 480-596-8522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2056
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: