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General NPI Number Information
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NPI Number | 1770990426
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Entity Type | Organization
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Legal Business Name | RENDEZVOUS MEDICAL
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 1035 ROSE LN SUITE D
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City | RIVERTON
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State | WY
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Zip | 82501-2286
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Country | US
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Telephone | 307-856-0382
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Fax | 307-856-0385
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Provider Business Mailing Address
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Address Line | 1035 ROSE LN SUITE D
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City | RIVERTON
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State | WY
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Zip | 82501-2286
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Country | US
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Telephone | 307-856-0382
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Fax | 307-856-0385
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Authorized Official
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Title or Position | CLINICAL MANAGER
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Name | MRS. CHRISTY D KRAUS
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Credential | RN
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Telephone | 307-856-4959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 261Q00000X
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License Number State | WY
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