Provider Demographics
NPI:1447387519
Name:ROCKY MOUNTAIN WOMEN'S HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN WOMEN'S HEALTH CENTER, INC.
Other - Org Name:ROCKY MOUNTAIN OBGYN PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:HOLDEN
Authorized Official - Middle Name:U
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-776-0880
Mailing Address - Street 1:PO BOX 844839
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4839
Mailing Address - Country:US
Mailing Address - Phone:877-210-9143
Mailing Address - Fax:314-432-9683
Practice Address - Street 1:1580 W ANTELOPE DR STE 290
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1179
Practice Address - Country:US
Practice Address - Phone:801-776-0880
Practice Address - Fax:801-773-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1447387519Medicaid
UTCH0973OtherRR MEDICARE
UTCH0973OtherRR MEDICARE