Full Name | |
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Speciality | Clinic/Center |
Location | 702 E 2nd St, Shoshoni, Wyoming |
Authorized Official Name and Position | Natalya Keller (CFO) |
Authorized Official Contact | 3078645065 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
120 N C Ave Thermopolis WY 82443-2410 Ph: (307) 864-5534 | 702 E 2nd St Shoshoni WY 82649 Ph: (307) 876-0221 |
NPI Number | 1407447766 |
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Provider Enumeration Date | 01/29/2021 |
Last Update Date | 09/04/2024 |
Medicare PECOS PAC ID | 9234020439 |
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Medicare Enrollment ID | O20220614000126 |
Identifier | Type | State | Issuer |
---|---|---|---|
1407447766 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |