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NPI Code Detail

MEDICARE: EDOA REM 2 MI LLC

MEDICARE: EDOA REM 2 MI LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223D0001XPublic Health Dentistry

General Provider Information

NPI Number : 1295687077
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDOA REM 2 MI LLC
Provider Business Mailing Address
First Line : 2934 W INA RD
Second Line :
City : TUCSON
State : AZ
Zip : 85741-2110
Country : US
Telephone Number : 520-848-0384
Fax Number :
Provider Business Practice Location Address
First Line : 2934 W INA RD
Second Line :
City : TUCSON
State : AZ
Zip : 85741-2110
Country : US
Telephone Number : 520-848-0384
Fax Number :
Authorized Official
Title or Position : HUMAN RESOURCES
Name : SHAYLA MOORE
Credential :
Telephone Number : 402-505-6843
Provider Enumeration Date : 02/12/2026
Last Update Date : 02/12/2026

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Directions to “EDOA REM 2 MI LLC ” Practice Location

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