MEDICARE: ROCKY MOUNTAIN FAMILY PRACTICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5212615-1205	UT

General Provider Information

NPI Number	:	1467527739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84011-0307
Country	:	US
Telephone Number	:	888-700-6907
Fax Number	:	801-294-6917

Provider Business Practice Location Address
First Line	:	1950 FORT UNION BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-6894
Country	:	US
Telephone Number	:	801-943-3300
Fax Number	:	801-891-1915

Authorized Official
Title or Position	:	OWNER
Name	:	DAVE KREMER
Credential	:
Telephone Number	:	801-973-2588

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	08/22/2020

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Directions to “ROCKY MOUNTAIN FAMILY PRACTICE ” Practice Location

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