MEDICARE: PMRM MEDICAL SERVICE 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	207Q00000X	Family Medicine Physician
2	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1578019956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PMRM MEDICAL SERVICE LLC

Provider Business Mailing Address
First Line	:	4650 E COTTON CENTER BLVD
Second Line	:	SUITE 250
City	:	PHOENIX
State	:	AZ
Zip	:	85040-4800
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4650 E COTTON CENTER BLVD
Second Line	:	SUITE 250
City	:	PHOENIX
State	:	AZ
Zip	:	85040-4800
Country	:	US
Telephone Number	:	602-481-7369
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. CHRISTINA BECKER
Credential	:	RN
Telephone Number	:	602-481-7369

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	08/29/2016

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Directions to “PMRM MEDICAL SERVICE LLC ” Practice Location

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