Provider Demographics
NPI:1073848305
Name:ROCKY MOUNTAIN MEDICAL , LLC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN MEDICAL , LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-700-4246
Mailing Address - Street 1:4240 NW 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-7603
Mailing Address - Country:US
Mailing Address - Phone:800-700-4246
Mailing Address - Fax:
Practice Address - Street 1:6714 N PITTSBURG
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217
Practice Address - Country:US
Practice Address - Phone:509-466-1250
Practice Address - Fax:800-576-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602942924332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1073848305Medicaid
ID1073848305Medicaid
OR1073848305Medicaid