MEDICARE: RTA HOSPICE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician
2	363LF0000X	Family Nurse Practitioner
3	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1760148332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RTA HOSPICE, LLC

Provider Business Mailing Address
First Line	:	10 CADILLAC DR STE 400
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-1001
Country	:	US
Telephone Number	:	417-841-4834
Fax Number	:	866-955-8538

Provider Business Practice Location Address
First Line	:	1940 MESQUITE AVE STE 1
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6123
Country	:	US
Telephone Number	:	928-302-2251
Fax Number	:	866-955-8548

Authorized Official
Title or Position	:	SVP, CHIEF LEGAL OFFICER
Name	:	RUSSELL ADKINS
Credential	:
Telephone Number	:	615-309-5668

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	11/09/2021

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