Provider Demographics
NPI:1649791062
Name:NORTHERN ROCKIES HOLDINGS
Entity type:Organization
Organization Name:NORTHERN ROCKIES HOLDINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-897-9200
Mailing Address - Street 1:6216 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84123-6630
Mailing Address - Country:US
Mailing Address - Phone:801-974-5555
Mailing Address - Fax:
Practice Address - Street 1:6216 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84123-6630
Practice Address - Country:US
Practice Address - Phone:801-974-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10390897-1714332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment