Provider Demographics
NPI:1962822338
Name:RISE MEDICAL SERVICES
Entity Type:Organization
Organization Name:RISE MEDICAL SERVICES
Other - Org Name:RMS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LADANA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-852-1510
Mailing Address - Street 1:81 HIGUERA ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5423
Mailing Address - Country:US
Mailing Address - Phone:805-852-1510
Mailing Address - Fax:805-888-2850
Practice Address - Street 1:81 HIGUERA ST
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5423
Practice Address - Country:US
Practice Address - Phone:805-852-1510
Practice Address - Fax:805-888-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201405810381305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service