| Family Care Clinic, Llc | |
|
204 Mccollum St Ste 104 Laramie WY 82070-5151 | |
| (307) 745-0085 | |
| (307) 745-0084 |
| Full Name | Family Care Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 204 Mccollum St Ste 104, Laramie, Wyoming |
| Authorized Official Name and Position | Teri Jean Ourada (OWNER) |
| Authorized Official Contact | 3077450085 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Care Clinic, Llc 204 Mccollum St Ste 104 Laramie WY 82070-5151 Ph: (307) 745-0085 | Family Care Clinic, Llc 204 Mccollum St Ste 104 Laramie WY 82070-5151 Ph: (307) 745-0085 |
| NPI Number | 1285777607 |
|---|---|
| Provider Enumeration Date | 02/15/2007 |
| Last Update Date | 04/30/2023 |
| Medicare PECOS PAC ID | 9739174525 |
|---|---|
| Medicare Enrollment ID | O20040420000459 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285777607 | NPI | - | NPPES |
| 118524100 | Medicaid | WY | |
| 53D1012895 | Other | WY | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Carla Jill Leinen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386725653 PECOS PAC ID: 5799770590 Enrollment ID: I20101206001064 |
| Provider Name | Teresa E Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124574629 PECOS PAC ID: 0143508036 Enrollment ID: I20161027001517 |
| Provider Name | Teri Jean Ourada |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700490489 PECOS PAC ID: 4486044377 Enrollment ID: I20211210001461 |
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