Provider Demographics
NPI:1083911291
Name:R MEDICAL OUTREACH AND ASSOCIATES LLC,
Entity Type:Organization
Organization Name:R MEDICAL OUTREACH AND ASSOCIATES LLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:ARJON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-595-8998
Mailing Address - Street 1:11601 PELLICANO DR
Mailing Address - Street 2:B-3
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6279
Mailing Address - Country:US
Mailing Address - Phone:915-595-8998
Mailing Address - Fax:915-595-6655
Practice Address - Street 1:11601 PELLICANO DR
Practice Address - Street 2:B-3
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6279
Practice Address - Country:US
Practice Address - Phone:915-595-8998
Practice Address - Fax:915-595-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281813002Medicaid
TX281813001Medicaid
TX281813002Medicaid