Healthcare Provider Details

I. General information

NPI: 1578283008
Provider Name (Legal Business Name): RITUAL MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 NE IRVING AVE
BEND OR
97701-4738
US

IV. Provider business mailing address

62472 QUAIL RIDGE RD
BEND OR
97701-9553
US

V. Phone/Fax

Practice location:
  • Phone: 541-255-1530
  • Fax: 541-219-5356
Mailing address:
  • Phone: 541-255-1530
  • Fax: 833-764-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW TRAVIS MULLANE
Title or Position: CEO, OWNER
Credential: MD MPH
Phone: 541-255-1530