Provider Demographics
NPI:1396018545
Name:RED ROCK MEDICAL SUPPLY
Entity Type:Organization
Organization Name:RED ROCK MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-485-6166
Mailing Address - Street 1:450 S 900 E
Mailing Address - Street 2:STE 100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2981
Mailing Address - Country:US
Mailing Address - Phone:801-886-9700
Mailing Address - Fax:801-531-1949
Practice Address - Street 1:1880 N 2200 W STE 40
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-4136
Practice Address - Country:US
Practice Address - Phone:801-886-9700
Practice Address - Fax:801-415-9423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-20
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1396018545Medicaid
UT1396018545Medicaid