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156 N. 6th Street Basin WY 82410-0388 | |
(307) 568-2499 | |
(307) 568-2699 |
Full Name | |
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Speciality | Family Medicine |
Location | 156 N. 6th Street, Basin, Wyoming |
Authorized Official Name and Position | Natalya Keller (CFO) |
Authorized Official Contact | 3078645065 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 388 156 N 6th Street Basin WY 82410-0388 Ph: (307) 568-2499 | 156 N. 6th Street Basin WY 82410-0388 Ph: (307) 568-2499 |
NPI Number | 1174524607 |
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Provider Enumeration Date | 08/09/2005 |
Last Update Date | 09/04/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174524607 | NPI | - | NPPES |
107327310 | Medicaid | WY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 5946A (Wyoming) | Secondary |
207Q00000X | Family Medicine | (Wyoming) | Primary |