Provider Demographics
NPI:1366735466
Name:RENDEZVOUS MEDICAL
Entity type:Organization
Organization Name:RENDEZVOUS MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-856-0382
Mailing Address - Street 1:1035 ROSE LN
Mailing Address - Street 2:SUITE B
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 B
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:2011-05-23
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty