Provider Demographics
NPI:1992309579
Name:ROCKY MOUNTAIN ROGUES, INC.
Entity type:Organization
Organization Name:ROCKY MOUNTAIN ROGUES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTOFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-654-7594
Mailing Address - Street 1:PO BOX 3447
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:WY
Mailing Address - Zip Code:83128-0447
Mailing Address - Country:US
Mailing Address - Phone:307-654-7593
Mailing Address - Fax:307-654-7594
Practice Address - Street 1:91 US HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:WY
Practice Address - Zip Code:83128
Practice Address - Country:US
Practice Address - Phone:307-654-7593
Practice Address - Fax:307-654-7494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals