Provider Demographics
NPI:1659435352
Name:ROCKY MOUNTAIN MEDICAL
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WARNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-294-0794
Mailing Address - Street 1:PO BOX 30215
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-0215
Mailing Address - Country:US
Mailing Address - Phone:406-294-0794
Mailing Address - Fax:
Practice Address - Street 1:2110 OVERLAND AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6480
Practice Address - Country:US
Practice Address - Phone:406-294-0794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5864310001Medicare NSC