Provider Demographics
NPI:1326089137
Name:ROCKY MOUNTAIN VEIN CLINIC, P.C.
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN VEIN CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:307-527-7129
Mailing Address - Street 1:2820 CENTRAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-8624
Mailing Address - Country:US
Mailing Address - Phone:406-896-2447
Mailing Address - Fax:406-896-2491
Practice Address - Street 1:125 W YELLOWSTONE AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8723
Practice Address - Country:US
Practice Address - Phone:307-527-7129
Practice Address - Fax:307-587-7394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6172A2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY123009300Medicaid
WYW20831Medicare PIN
MT000085445Medicare PIN
F86477Medicare UPIN