Healthcare Provider Details

I. General information

NPI: 1861770414
Provider Name (Legal Business Name): RMC MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 3RD W
SODA SPRINGS ID
83276-1559
US

IV. Provider business mailing address

PO BOX 3599
IDAHO FALLS ID
83403-3599
US

V. Phone/Fax

Practice location:
  • Phone: 208-547-3341
  • Fax:
Mailing address:
  • Phone: 208-525-2090
  • Fax: 208-523-8978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM-4186
License Number StateID

VIII. Authorized Official

Name: MR. ROLAND FLECK
Title or Position: OWNER
Credential: M.D.
Phone: 208-525-2090