Organization Name: | ROCKY MOUNTAIN CLINICAL LLC |
NPI Number: | 1194956342 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GARY GARNER (OWNER) |
Mailing Address: | 1594 W 300 N Pleasant Grove |
State: | UT US |
Postal Code: | 84062 |
Phone Number: | 8015928536 |
Fax Number: | |
NPI Enumeration Date: | 08/06/2009 |
NPI Last Update Date: | 08/06/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 150719-1205 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |