| Holistic Pain Management Of Wyoming, Llc | |
|
1001 W Main St Riverton WY 82501-3230 | |
| (307) 271-2332 | |
| Not Available |
| Full Name | Holistic Pain Management Of Wyoming, Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1001 W Main St, Riverton, Wyoming |
| Authorized Official Name and Position | Ryan Shedd (CEO) |
| Authorized Official Contact | 3072712332 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Holistic Pain Management Of Wyoming, Llc 1001 W Main St Ste B Riverton WY 82501-3230 Ph: (307) 271-2332 | Holistic Pain Management Of Wyoming, Llc 1001 W Main St Riverton WY 82501-3230 Ph: (307) 271-2332 |
| NPI Number | 1487295846 |
|---|---|
| Provider Enumeration Date | 10/07/2019 |
| Last Update Date | 10/20/2022 |
| Medicare PECOS PAC ID | 0840621322 |
|---|---|
| Medicare Enrollment ID | O20200518000889 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487295846 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Mary Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639263650 PECOS PAC ID: 7810922093 Enrollment ID: I20081201000347 |
| Provider Name | Jennifer R Tryder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780936419 PECOS PAC ID: 0345493250 Enrollment ID: I20121228000426 |
| Provider Name | Amanda Bisby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538687652 PECOS PAC ID: 7719245943 Enrollment ID: I20171218001301 |
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