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General NPI Number Information
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NPI Number | 1417008269
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN EKG
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2313 TIERRA ROSE DR
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City | WEST JORDAN
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State | UT
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Zip | 84084-5812
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Country | US
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Telephone | 801-641-8031
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Fax | 801-849-8432
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Provider Business Mailing Address
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Address Line | 2313 TIERRA ROSE DR
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City | WEST JORDAN
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State | UT
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Zip | 84084-5812
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Country | US
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Telephone | 801-641-8031
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Fax | 801-849-8432
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Authorized Official
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Title or Position | RN, DIRECTOR
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Name | MR. JAMES PAUL NEIDER
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Credential | RN
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Telephone | 801-641-8031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 6304541-3102
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License Number State | UT
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