| Glenrock Health Center | |
|
925 W Birch St Glenrock WY 82637-0786 | |
| (307) 436-9206 | |
| (307) 436-9730 |
| Full Name | Glenrock Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 925 W Birch St, Glenrock, Wyoming |
| Authorized Official Name and Position | Melanie Cielinski (ADMINISTRATOR) |
| Authorized Official Contact | 3074369206 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glenrock Health Center Po Box 786 Glenrock WY 82637-0786 Ph: (307) 436-9206 | Glenrock Health Center 925 W Birch St Glenrock WY 82637-0786 Ph: (307) 436-9206 |
| NPI Number | 1093758161 |
|---|---|
| Provider Enumeration Date | 06/14/2006 |
| Last Update Date | 12/04/2019 |
| Medicare PECOS PAC ID | 8527976828 |
|---|---|
| Medicare Enrollment ID | O20040604000855 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093758161 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Joseph E Mickelson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467448043 PECOS PAC ID: 2668365008 Enrollment ID: I20050822000307 |
| Provider Name | Donald L Coulter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093248114 PECOS PAC ID: 6507135076 Enrollment ID: I20170627002495 |
| Provider Name | Audrey N Mathson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477044261 PECOS PAC ID: 9032464011 Enrollment ID: I20180614002217 |
| Provider Name | Ashley M Oviedo Lopez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841797461 PECOS PAC ID: 1456699446 Enrollment ID: I20200618000442 |
Oregon Trail Rural Health Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 525 East Birch Street, Glenrock, WY 82637 Phone: 307-436-8838 Fax: 307-436-2476 |