MEDICARE: ROCKY MOUNTAIN MEDICAL LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RR0500X	Rheumatology Physician
2	2084N0400X	Neurology Physician
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1932041811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN MEDICAL LLC

Provider Business Mailing Address
First Line	:	535 W SUNNYSIDE RD STE 2
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-4647
Country	:	US
Telephone Number	:	208-291-1208
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 W SUNNYSIDE RD STE 2
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-4647
Country	:	US
Telephone Number	:	208-330-3007
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MATTHEW WOOD
Credential	:
Telephone Number	:	208-291-1208

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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Directions to “ROCKY MOUNTAIN MEDICAL LLC ” Practice Location

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