Healthcare Provider Details

I. General information

NPI: 1003862723
Provider Name (Legal Business Name): ROCKY MOUNTAIN ONCOLOGY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 EAST 2ND STREET
CASPER WY
82609-4293
US

IV. Provider business mailing address

6501 EAST 2ND STREET
CASPER WY
82609-4293
US

V. Phone/Fax

Practice location:
  • Phone: 307-235-5433
  • Fax: 307-233-4700
Mailing address:
  • Phone: 307-235-5433
  • Fax: 307-233-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number4463A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16021.02
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2438A
License Number StateWY

VIII. Authorized Official

Name: MR. ROBERT RHYMER
Title or Position: COO
Credential:
Phone: 615-467-7415