MEDICARE: ROCKY MOUNTAIN HOLDINGS LLC

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	3416A0800X	Air Ambulance	185	SC

General Provider Information

NPI Number	:	1508147794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN HOLDINGS LLC

Provider Business Mailing Address
First Line	:	621 CARNEGIE DR
Second Line	:	STE 210
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3536
Country	:	US
Telephone Number	:	909-915-2303
Fax Number	:	402-952-2411

Provider Business Practice Location Address
First Line	:	550 AIRPORT RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-6205
Country	:	US
Telephone Number	:	909-915-2303
Fax Number	:	402-952-2411

Authorized Official
Title or Position	:	VP OF PATIENT BUSINESS SERVICES
Name	:	MARK KEENE
Credential	:
Telephone Number	:	909-915-2301

Provider Enumeration Date	:	09/01/2011
Last Update Date	:	09/01/2011

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