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5647 Us Hwy 26 Dubois WY 82513-0577 | |
(307) 455-2516 | |
(307) 455-2526 |
Full Name | |
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Speciality | Clinic/Center |
Location | 5647 Us Hwy 26, Dubois, Wyoming |
Authorized Official Name and Position | Amanda Sisco (REVENUE CYCLE MANAGER) |
Authorized Official Contact | 3072336000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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5000 Blackmore Rd Casper WY 82609-3345 Ph: (307) 233-6000 | 5647 Us Hwy 26 Dubois WY 82513-0577 Ph: (307) 455-2516 |
NPI Number | 1306136205 |
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Provider Enumeration Date | 04/12/2011 |
Last Update Date | 03/08/2024 |
Medicare PECOS PAC ID | 3375454705 |
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Medicare Enrollment ID | O20110708000289 |
Identifier | Type | State | Issuer |
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1306136205 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |