Provider Demographics
NPI:1578019956
Name:PMRM MEDICAL SERVICE LLC
Entity Type:Organization
Organization Name:PMRM MEDICAL SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-481-7369
Mailing Address - Street 1:4650 E COTTON CENTER BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-4800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4650 E COTTON CENTER BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-4800
Practice Address - Country:US
Practice Address - Phone:602-481-7369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ12932Medicare PIN