Provider Demographics
NPI:1770990426
Name:RENDEZVOUS MEDICAL
Entity type:Organization
Organization Name:RENDEZVOUS MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-856-4959
Mailing Address - Street 1:1035 ROSE LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-2286
Mailing Address - Country:US
Mailing Address - Phone:307-856-0382
Mailing Address - Fax:307-856-0385
Practice Address - Street 1:1035 ROSE LN
Practice Address - Street 2:SUITE D
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2286
Practice Address - Country:US
Practice Address - Phone:307-856-0382
Practice Address - Fax:307-856-0385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY261Q00000X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW26111Medicare PIN