| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1233 E 2nd St, Casper, Wyoming |
| Authorized Official Name and Position | Kelly J Howard (DIRECTOR) |
| Authorized Official Contact | 8014421425 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 27128 Salt Lake City UT 84127-0128 Ph: (801) 507-3533 | 1233 E 2nd St Casper WY 82601-2926 Ph: (801) 507-3500 |
| NPI Number | 1164656005 |
|---|---|
| Provider Enumeration Date | 05/06/2009 |
| Last Update Date | 05/06/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164656005 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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