Provider Demographics
NPI:1164650719
Name:ROCKY MOUNTAIN FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:307-315-6133
Mailing Address - Street 1:5840 E 2ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4363
Mailing Address - Country:US
Mailing Address - Phone:307-315-6133
Mailing Address - Fax:307-315-6134
Practice Address - Street 1:5840 E 2ND ST. SUITE 200
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601
Practice Address - Country:US
Practice Address - Phone:307-315-6133
Practice Address - Fax:307-315-6134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care