Goose Creek Family Practice, P.c. | |
304 Coffeen Ave Suite A Sheridan WY 82801-4803 | |
(307) 674-1744 | |
(307) 674-1752 |
Full Name | Goose Creek Family Practice, P.c. |
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Speciality | Clinic/Center |
Location | 304 Coffeen Ave, Sheridan, Wyoming |
Authorized Official Name and Position | Debra Ann Kawulok (PRESIDENT) |
Authorized Official Contact | 3076741744 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Goose Creek Family Practice, P.c. 304 Coffeen Ave Suite A Sheridan WY 82801-4803 Ph: (307) 674-1744 | Goose Creek Family Practice, P.c. 304 Coffeen Ave Suite A Sheridan WY 82801-4803 Ph: (307) 674-1744 |
NPI Number | 1134407356 |
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Provider Enumeration Date | 07/22/2011 |
Last Update Date | 11/09/2012 |
Medicare PECOS PAC ID | 8921277419 |
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Medicare Enrollment ID | O20110818000447 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134407356 | NPI | - | NPPES |
1013242502 | Other | NPI # |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | 11988.1019 (Wyoming) | Primary |
Provider Name | Debra A Kawulok |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013242502 PECOS PAC ID: 7416096607 Enrollment ID: I20091201000425 |
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