| James L. Derrico Dds Llc | |
|
1130 S Hwy 89 Jackson WY 83001-8512 | |
| (307) 200-6644 | |
| Not Available |
| Full Name | James L. Derrico Dds Llc |
|---|---|
| Speciality | Durable Medical Equipment & Medical Supplies |
| Location | 1130 S Hwy 89, Jackson, Wyoming |
| Authorized Official Name and Position | James L Derrico (OWNER) |
| Authorized Official Contact | 6303997367 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| James L. Derrico Dds Llc Po Box 806 Jackson WY 83001-0806 Ph: (630) 399-7367 | James L. Derrico Dds Llc 1130 S Hwy 89 Jackson WY 83001-8512 Ph: (307) 200-6644 |
| NPI Number | 1235700014 |
|---|---|
| Provider Enumeration Date | 07/02/2021 |
| Last Update Date | 08/03/2023 |
| Medicare PECOS PAC ID | 6002274354 |
|---|---|
| Medicare Enrollment ID | O20230620001595 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235700014 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Primary |
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