Healthcare Provider Details

I. General information

NPI: 1306214606
Provider Name (Legal Business Name): RR MEDCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E SAMPLE RD SUITE 320
POMPANO BEACH FL
33064-3554
US

IV. Provider business mailing address

100 E SAMPLE RD SUITE 320
POMPANO BEACH FL
33064-3554
US

V. Phone/Fax

Practice location:
  • Phone: 754-264-7540
  • Fax: 754-222-9389
Mailing address:
  • Phone: 754-264-7540
  • Fax: 754-222-9389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND DI IULIO
Title or Position: MANAGING MEMBER
Credential:
Phone: 754-264-7540