Healthcare Provider Details

I. General information

NPI: 1164019642
Provider Name (Legal Business Name): ROCKY MOUNTAIN HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 21ST ST
ROSWELL NM
88201-3384
US

IV. Provider business mailing address

PO BOX 713362
CINCINNATI OH
45271-3362
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 Number
License Number State

VIII. Authorized Official

Name: SHARON J KECK
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 303-792-7400