Provider Demographics
NPI:1578283008
Name:RITUAL MEDICAL LLC
Entity Type:Organization
Organization Name:RITUAL MEDICAL LLC
Other - Org Name:RITUAL MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:541-255-1530
Mailing Address - Street 1:1116 NE ULYSSES DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3967
Mailing Address - Country:US
Mailing Address - Phone:541-255-1530
Mailing Address - Fax:
Practice Address - Street 1:711 NE IRVING AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4738
Practice Address - Country:US
Practice Address - Phone:541-255-1530
Practice Address - Fax:541-219-5356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty