Healthcare Provider Details

I. General information

NPI: 1265689905
Provider Name (Legal Business Name): ROCKY MOUNTAIN CRITICAL CARE ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E SOUTH TEMPLE 3RD FLOOR
SALT LAKE CITY UT
84102-1507
US

IV. Provider business mailing address

1858 NEVADA STREET
SALT LAKE CITY UT
84108
US

V. Phone/Fax

Practice location:
  • Phone: 801-505-5223
  • Fax:
Mailing address:
  • Phone: 623-206-9238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number360805-1205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANGELA S BOYLE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 623-206-9238