Provider Demographics
NPI:1932338530
Name:RED ROCK FAMILY PRACTICE, INC
Entity Type:Organization
Organization Name:RED ROCK FAMILY PRACTICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPARTMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:LIN
Authorized Official - Last Name:GRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-864-5534
Mailing Address - Street 1:120 N C AVE
Mailing Address - Street 2:
Mailing Address - City:THERMOPOLIS
Mailing Address - State:WY
Mailing Address - Zip Code:82443-2410
Mailing Address - Country:US
Mailing Address - Phone:307-864-5534
Mailing Address - Fax:307-864-9470
Practice Address - Street 1:1125 CHARLES AVE
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-4021
Practice Address - Country:US
Practice Address - Phone:307-347-2449
Practice Address - Fax:307-864-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty