Provider Demographics
NPI:1467427617
Name:RIMKUS, RICHARD V (PAC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:V
Last Name:RIMKUS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8144 E CACTUS RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5266
Mailing Address - Country:US
Mailing Address - Phone:480-596-8525
Mailing Address - Fax:480-596-8522
Practice Address - Street 1:8144 E CACTUS RD
Practice Address - Street 2:SUITE 800
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5266
Practice Address - Country:US
Practice Address - Phone:480-596-8525
Practice Address - Fax:480-596-8522
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2056363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ418443Medicaid
AZAZ0144700OtherBC/BS OF ARIZONA
AZAZ0144700OtherBC/BS OF ARIZONA
AZR58158Medicare UPIN