Provider Demographics
NPI:1619526811
Name:RED ROCK MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:RED ROCK MEDICAL SUPPLY LLC
Other - Org Name:RED ROCK MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LISKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-886-9700
Mailing Address - Street 1:450 S 900 E STE 100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2983
Mailing Address - Country:US
Mailing Address - Phone:801-886-9700
Mailing Address - Fax:801-415-9423
Practice Address - Street 1:1763 W MARCON LN STE 150
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8202
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:2019-09-10
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1396018545Medicaid