Organization Name: | RED ROCK FAMILY PRACTICE, PC |
NPI Number: | 1023247624 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JENIFER LIN GRIMM (BILLING DEPARTMENT) |
Mailing Address: | 1125 Charles Ave Worland |
State: | WY US |
Postal Code: | 824014021 |
Phone Number: | 3073472449 |
Fax Number: | 3073476187 |
NPI Enumeration Date: | 07/06/2009 |
NPI Last Update Date: | 11/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |