Healthcare Provider Details

I. General information

NPI: 1558208215
Provider Name (Legal Business Name): ROCKY MOUNTAIN RHEUMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 6TH AVE S
GREAT FALLS MT
59405-3013
US

IV. Provider business mailing address

14 GEMINI CT
GREAT FALLS MT
59404-6367
US

V. Phone/Fax

Practice location:
  • Phone: 406-868-1784
  • Fax:
Mailing address:
  • Phone: 406-868-1784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: STACEY JOHNSON
Title or Position: OWNER/PROVIDER
Credential: FNP-C
Phone: 406-868-1784