Provider Demographics
NPI:1003862723
Name:ROCKY MOUNTAIN ONCOLOGY CENTER, LLC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN ONCOLOGY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RHYMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-467-7415
Mailing Address - Street 1:6501 EAST 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4293
Mailing Address - Country:US
Mailing Address - Phone:307-235-5433
Mailing Address - Fax:307-233-4700
Practice Address - Street 1:6501 EAST 2ND STREET
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4293
Practice Address - Country:US
Practice Address - Phone:307-235-5433
Practice Address - Fax:307-233-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4463A2085R0001X
WY16021.02363LF0000X
WY2438A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY121006800Medicaid
WY121006800Medicaid