NPIMap

Organization Active NPI

Rocky Mountain Artificial Limb & Brace, Inc

  • Prosthetic/Orthotic Supplier
  • Logan, UT
National Provider Identifier
1679630032
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
ROCKY MOUNTAIN ARTIFICIAL LIMB & BRACE, INC
Practice address
1515 N. 400 E
Logan, UT 84341
Phone
(435) 753-5100
Fax
(435) 753-5105
NPI assigned
Jan 3, 2007
Last updated
Sep 26, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
BULOW HOLDINGS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bradford Gardner
Title
VP, Coo
Phone
(615) 550-8760

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X NU Primary

Addresses

Primary practice location

1515 N. 400 E
Logan, UT 84341

Mailing address

102 Woodmont Blvd
Suite 120
Nashville, TN 37205
Phone (615) 550-8774

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930081230 UT DME Supplier - Orthotic PersonnelDME Supplier - Prosthetic Personnel 6103943295 Practice locations: North Logan, UT

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Rocky Mountain Artificial Limb & BR1515 N 400 E, North Logan, UT 84341-7578(435) 753-5100 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Rocky Mountain Artificial Limb Brace Inc3 organizations share this tax ID, including this one
Part of
Bulow Holdings LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1515 N 400 E
Ste 100
North Logan, UT 84341
Phone (435) 753-5100

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727308800000",
    "number": "1679630032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 WOODMONT BLVD",
            "address_2": "SUITE 120",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "37205",
            "telephone_number": "615-550-8774",
            "fax_number": "615-454-5352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 N. 400 E",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "84341",
            "telephone_number": "435-753-5100",
            "fax_number": "435-753-5105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKY MOUNTAIN ARTIFICIAL LIMB & BRACE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BULOW HOLDINGS, LLC",
        "enumeration_date": "2007-01-03",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "BRADFORD",
        "authorized_official_title_or_position": "VP, COO",
        "authorized_official_telephone_number": "615-550-8760"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.