MEDICARE: ROCKY MOUNTAIN MEDICAL CENTER, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	284300000X	Special Hospital	008165	TX

General Provider Information

NPI Number	:	1588661029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN MEDICAL CENTER, LP

Provider Business Mailing Address
First Line	:	2801 S MAYHILL RD
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76208-5910
Country	:	US
Telephone Number	:	940-220-0600
Fax Number	:	940-220-0605

Provider Business Practice Location Address
First Line	:	2801 S MAYHILL RD
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76208-5910
Country	:	US
Telephone Number	:	940-220-0600
Fax Number	:	940-220-0605

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. RANDY B BACUS
Credential	:
Telephone Number	:	940-220-0600

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	08/22/2020

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