Provider Demographics
NPI:1952710667
Name:ROCKY MOUNTAIN HOLDINGS, LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN HOLDINGS, LLC
Other - Org Name:JEFFSTAT AIR AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-915-2304
Mailing Address - Street 1:621 CARNEGIE DR
Mailing Address - Street 2:210
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3536
Mailing Address - Country:US
Mailing Address - Phone:909-915-2304
Mailing Address - Fax:402-952-2427
Practice Address - Street 1:400 MEDICAL CENTER DR STE A
Practice Address - Street 2:SUITE 1
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2362
Practice Address - Country:US
Practice Address - Phone:856-269-4354
Practice Address - Fax:856-269-4493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNUMBER NOT LISTED3416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ262364Medicare Oscar/Certification