Provider Demographics
NPI:1417008269
Name:ROCKY MOUNTAIN EKG
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN EKG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:NEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:801-641-8031
Mailing Address - Street 1:2313 TIERRA ROSE DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-5812
Mailing Address - Country:US
Mailing Address - Phone:801-641-8031
Mailing Address - Fax:801-849-8432
Practice Address - Street 1:2313 TIERRA ROSE DR
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-5812
Practice Address - Country:US
Practice Address - Phone:801-641-8031
Practice Address - Fax:801-849-8432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6304541-3102261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center