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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 - Federally Qualified Health Center (fqhc) |
Location | 5647 Us Hwy 26, Dubois, Wyoming |
Authorized Official Name and Position | Catherine E Keene (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 3078576685 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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511 N. 12th St. E Riverton WY 82501-3809 Ph: (307) 857-6685 | 5647 Us Hwy 26 Dubois WY 82513-0577 Ph: (307) 455-2516 |
NPI Number | 1700964699 |
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Provider Enumeration Date | 11/01/2006 |
Last Update Date | 03/11/2010 |
Identifier | Type | State | Issuer |
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1700964699 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |