Full Name | |
---|---|
Speciality | Clinic/center |
Location | 1025 9th St, Cody, Wyoming |
Authorized Official Name and Position | Jason L. Barker (PRESIDENT/CEO) |
Authorized Official Contact | 4062373070 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1025 9th St Cody WY 82414-3441 Ph: (877) 587-2955 | 1025 9th St Cody WY 82414-3441 Ph: (877) 587-2955 |
NPI Number | 1013227016 |
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Provider Enumeration Date | 10/12/2010 |
Last Update Date | 10/25/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1013227016 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 12129 (Montana) | Primary |
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