Healthcare Provider Details

I. General information

NPI: 1497833180
Provider Name (Legal Business Name): ROCKY MOUNTAIN INFECTIOUS DISEASES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 E A ST STE 1 & 2
CASPER WY
82601-2239
US

IV. Provider business mailing address

1450 E A ST
CASPER WY
82601-2239
US

V. Phone/Fax

Practice location:
  • Phone: 307-234-8700
  • Fax: 307-234-8750
Mailing address:
  • Phone: 307-234-8700
  • Fax: 307-234-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number5197A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6725430001
License Number StateWY

VIII. Authorized Official

Name: BRANDY R HASKINS
Title or Position: FINANCIAL MANAGER
Credential:
Phone: 307-234-8700