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General NPI Number Information
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NPI Number | 1306214606
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Entity Type | Organization
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Legal Business Name | RR MEDCO LLC
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 07/24/2017
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Provider Practice Location Address
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Address Line | 100 E SAMPLE RD SUITE 320
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City | POMPANO BEACH
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State | FL
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Zip | 33064-3554
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Country | US
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Telephone | 754-264-7540
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Fax | 754-222-9389
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Provider Business Mailing Address
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Address Line | 100 E SAMPLE RD SUITE 320
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City | POMPANO BEACH
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State | FL
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Zip | 33064-3554
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Country | US
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Telephone | 754-264-7540
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Fax | 754-222-9389
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. RAYMOND DI IULIO
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Credential |
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Telephone | 754-264-7540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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