Provider Demographics
NPI:1033471941
Name:R&R MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:R&R MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PUDIWITR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-306-4505
Mailing Address - Street 1:7332 E BUTHERUS DR
Mailing Address - Street 2:HANGAR ONE
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2426
Mailing Address - Country:US
Mailing Address - Phone:623-866-9250
Mailing Address - Fax:623-252-0109
Practice Address - Street 1:655 S GREEN VALLEY PKWY
Practice Address - Street 2:STE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-0404
Practice Address - Country:US
Practice Address - Phone:702-431-7337
Practice Address - Fax:702-431-1738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVE0271022011-6261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care