Healthcare Provider Details

I. General information

NPI: 1285919167
Provider Name (Legal Business Name): ROCKY MOUNTAIN HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 HIGHLAND AVE
AUGUSTA GA
30904
US

IV. Provider business mailing address

PO BOX 84621
SEATTLE WA
98124-5921
US

V. Phone/Fax

Practice location:
  • Phone: 909-915-2303
  • Fax: 402-952-2411
Mailing address:
  • Phone: 909-915-2303
  • Fax: 402-952-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number0496
License Number StateGA

VIII. Authorized Official

Name: MICHAEL DENNIS ALLEN
Title or Position: VICE PRESIDENT
Credential:
Phone: 909-915-2303