MEDICARE: ROCKY MOUNTAIN HOLDINGS, LLC

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	3416A0800X	Air Ambulance	10189	TN
2	3416A0800X	Air Ambulance

General Provider Information

NPI Number	:	1659887545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 713362
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45271-3362
Country	:	US
Telephone Number	:	888-636-4438
Fax Number	:

Provider Business Practice Location Address
First Line	:	4570 S JEFFERSON AVE
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-7696
Country	:	US
Telephone Number	:	888-636-4438
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	CHRISTOPHER J BRADY
Credential	:
Telephone Number	:	888-636-4438

Provider Enumeration Date	:	12/14/2017
Last Update Date	:	12/04/2025

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