Provider Demographics
NPI:1316419088
Name:ROCKY MOUNTAIN MOBILE IMAGING, LLC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN MOBILE IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEMAI
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:AAGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-220-1043
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:MCCAMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83250-0323
Mailing Address - Country:US
Mailing Address - Phone:208-220-1043
Mailing Address - Fax:307-278-7322
Practice Address - Street 1:887 E NORTH ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-3045
Practice Address - Country:US
Practice Address - Phone:208-220-1043
Practice Address - Fax:307-278-7322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
11-35483-01OtherNRC