Healthcare Provider Details

I. General information

NPI: 1508143678
Provider Name (Legal Business Name): ROCKY MOUNTAIN HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23301 AIRPORT ROAD
DINWIDDLE VA
23250
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 909-915-2303
  • Fax: 402-952-2411
Mailing address:
  • Phone: 909-915-2303
  • Fax: 402-952-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number1186
License Number StateVA

VIII. Authorized Official

Name: MARK KEENE
Title or Position: VP OF PATIENT BUSINESS SERVICES
Credential:
Phone: 909-915-2303