MEDICARE: CEDAR MOUNTAIN MANAGEMENT, 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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1568321636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDAR MOUNTAIN MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	PO BOX 3108
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82902-3108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2223 REAGAN AVE UNIT 203
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4469
Country	:	US
Telephone Number	:	970-749-3238
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RANDALL RICE
Credential	:
Telephone Number	:	970-749-3238

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/29/2026

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