Healthcare Provider Details

I. General information

NPI: 1700273802
Provider Name (Legal Business Name): ROCKY MOUNTAIN HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 ACADEMY DR
HATTIESBURG MS
39401-7959
US

IV. Provider business mailing address

621 CARNEGIE DR STE 210
SAN BERNARDINO CA
92408-3536
US

V. Phone/Fax

Practice location:
  • Phone: 888-636-4438
  • Fax:
Mailing address:
  • Phone: 888-636-4438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number1191
License Number StateMS

VIII. Authorized Official

Name: MARL RAYMOND KEENE
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 909-915-2301