| |
1700 Westland Rd Cheyenne WY 82001-3322 | |
(307) 635-9291 | |
(307) 632-6131 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1700 Westland Rd, Cheyenne, Wyoming |
Authorized Official Name and Position | Cj Luce (CFO) |
Authorized Official Contact | 3076359291 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 106 Cheyenne WY 82003-0106 Ph: (307) 635-9291 | 1700 Westland Rd Cheyenne WY 82001-3322 Ph: (307) 635-9291 |
NPI Number | 1043436983 |
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Provider Enumeration Date | 04/18/2007 |
Last Update Date | 09/27/2024 |
Medicare PECOS PAC ID | 4385792555 |
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Medicare Enrollment ID | O20151222001392 |
Identifier | Type | State | Issuer |
---|---|---|---|
1043436983 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 20234.0234 (Wyoming) | Primary |
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