=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982490926
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RELATYV MOBILE MEDICAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2025
-----------------------------------------------------
Last Update Date | 05/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 171 COUNTRY GDNS
-----------------------------------------------------
City | LA VERNIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78121-9541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-870-4949
-----------------------------------------------------
Fax | 877-285-0477
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 171 COUNTRY GDNS
-----------------------------------------------------
City | LA VERNIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78121-9541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-870-4949
-----------------------------------------------------
Fax | 877-285-0477
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTRACT MANAGER
-----------------------------------------------------
Name | JANICE COMPTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 830-832-9703
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246Z00000X
-----------------------------------------------------
Taxonomy Name | Other Specialist/Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------