MEDICARE: RIO WEST MEDICAL, 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
1	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	202003149	OTHER	NM	PRESBYTERIAN NM
4	NM01TA20	OTHER	NM	BCBSNM
5	201065393	OTHER	NM	PRESBYTERIAN NM

General Provider Information

NPI Number	:	1396705687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIO WEST MEDICAL, LLC

Provider Business Mailing Address
First Line	:	PO BOX 44787
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87174-4787
Country	:	US
Telephone Number	:	505-896-0533
Fax Number	:	505-896-0522

Provider Business Practice Location Address
First Line	:	6200 COORS BLVD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-2785
Country	:	US
Telephone Number	:	505-896-0533
Fax Number	:	505-896-0522

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SANDRA YAUK
Credential	:	C PED
Telephone Number	:	505-896-0533

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	11/14/2008

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Directions to “RIO WEST MEDICAL, LLC ” Practice Location

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