| 307 Longevity Pc | |
|
1120 Beck Ave Cody WY 82414-3624 | |
| (307) 527-0355 | |
| (307) 527-0360 |
| Full Name | 307 Longevity Pc |
|---|---|
| Speciality | Clinic/center |
| Location | 1120 Beck Ave, Cody, Wyoming |
| Authorized Official Name and Position | Christopher Thoma (OWNER) |
| Authorized Official Contact | 3078990009 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 307 Longevity Pc Po Box 308 Wapiti WY 82450-0308 Ph: (307) 899-0009 | 307 Longevity Pc 1120 Beck Ave Cody WY 82414-3624 Ph: (307) 527-0355 |
| NPI Number | 1316783673 |
|---|---|
| Provider Enumeration Date | 07/06/2024 |
| Last Update Date | 07/06/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316783673 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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