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514 Idaho Dr Medicine Bow WY 82329-0037 | |
(307) 379-2222 | |
(307) 379-2223 |
Full Name | |
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Speciality | Clinic/Center |
Location | 514 Idaho Dr, Medicine Bow, Wyoming |
Authorized Official Name and Position | Adam Barron (MA/CPT/EMT) |
Authorized Official Contact | 3073792222 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 37 514 Idaho Dr Medicine Bow WY 82329-0037 Ph: (307) 379-2222 | 514 Idaho Dr Medicine Bow WY 82329-0037 Ph: (307) 379-2222 |
NPI Number | 1487756102 |
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Provider Enumeration Date | 09/02/2006 |
Last Update Date | 03/03/2022 |
Medicare PECOS PAC ID | 5799795985 |
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Medicare Enrollment ID | O20060503000104 |
Identifier | Type | State | Issuer |
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1487756102 | NPI | - | NPPES |
106597100 | Medicaid | WY |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | William Carey Lake |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1497390017 PECOS PAC ID: 6204261977 Enrollment ID: I20200128000149 |