Full Name | |
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Speciality | Family Medicine |
Location | 122 Main Street, Hulett, Wyoming |
Authorized Official Name and Position | Micki Dahne Lyons (CEO) |
Authorized Official Contact | 3072833501 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 517 713 Oak Street Sundance WY 82729-0517 Ph: (307) 283-3501 | 122 Main Street Hulett WY 82720 Ph: (307) 467-5281 |
NPI Number | 1912075102 |
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Provider Enumeration Date | 12/04/2006 |
Last Update Date | 10/16/2020 |
Medicare PECOS PAC ID | 9234032483 |
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Medicare Enrollment ID | O20101026001460 |
Identifier | Type | State | Issuer |
---|---|---|---|
1912075102 | NPI | - | NPPES |
106178007 | Medicaid | WY | |
106178003 | Medicaid | WY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |