MEDICARE: RRM MEDICAL PLLC

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	207L00000X	Anesthesiology Physician	4713	OK

General Provider Information

NPI Number	:	1639570427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RRM MEDICAL PLLC

Provider Business Mailing Address
First Line	:	4131 NW 122ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8869
Country	:	US
Telephone Number	:	405-775-9350
Fax Number	:	405-775-9360

Provider Business Practice Location Address
First Line	:	3048 SW 89TH ST STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6359
Country	:	US
Telephone Number	:	405-703-1302
Fax Number	:	405-703-1649

Authorized Official
Title or Position	:	SOLE OWNER/MEMBER
Name	:	RACHEL RAE MCKINZIE
Credential	:	D.O.
Telephone Number	:	405-775-9350

Provider Enumeration Date	:	09/11/2014
Last Update Date	:	09/11/2014

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