Provider Demographics
NPI:1265487854
Name:ROCKY MOUNTAIN MEDICAL, INC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LUNDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-255-0415
Mailing Address - Street 1:9171 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-6215
Mailing Address - Country:US
Mailing Address - Phone:801-255-0415
Mailing Address - Fax:801-255-0459
Practice Address - Street 1:9171 S 700 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-6215
Practice Address - Country:US
Practice Address - Phone:801-255-0415
Practice Address - Fax:801-255-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTF34288332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0578470001Medicare ID - Type Unspecified