Healthcare Provider Details

I. General information

NPI: 1487683215
Provider Name (Legal Business Name): ROCKY MOUNTAIN ANESTHESIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5475 S 500 E
OGDEN UT
84405-6905
US

IV. Provider business mailing address

2221 LAKESIDE BLVD STE 600
RICHARDSON TX
75082-4416
US

V. Phone/Fax

Practice location:
  • Phone: 800-880-3566
  • Fax: 801-432-2670
Mailing address:
  • Phone: 972-761-5508
  • Fax: 469-436-3932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANNA HARRISON
Title or Position: SR MANAGER SHARED SERVICES
Credential:
Phone: 972-761-5508