Provider Demographics
NPI:1295580082
Name:ROCKY MOUNTAIN MEDICAL LLC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-357-9700
Mailing Address - Street 1:535 W SUNNYSIDE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-4647
Mailing Address - Country:US
Mailing Address - Phone:208-357-9700
Mailing Address - Fax:
Practice Address - Street 1:535 W SUNNYSIDE RD STE 2
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-4647
Practice Address - Country:US
Practice Address - Phone:208-357-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty