Healthcare Provider Details

I. General information

NPI: 1932041811
Provider Name (Legal Business Name): ROCKY MOUNTAIN MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 W SUNNYSIDE RD STE 2
IDAHO FALLS ID
83402-4647
US

IV. Provider business mailing address

535 W SUNNYSIDE RD STE 2
IDAHO FALLS ID
83402-4647
US

V. Phone/Fax

Practice location:
  • Phone: 208-330-3007
  • Fax:
Mailing address:
  • Phone: 208-291-1208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW WOOD
Title or Position: DIRECTOR
Credential:
Phone: 208-291-1208