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388 South Us Hwy 20 Basin WY 82410-8902 | |
(307) 568-3311 | |
(307) 568-2139 |
Full Name | |
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Speciality | Clinic/Center |
Location | 388 South Us Hwy 20, Basin, Wyoming |
Authorized Official Name and Position | Joel Jackson (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 3075681426 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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388 South Us Hwy 20 Basin WY 82410-8902 Ph: (307) 568-3311 | 388 South Us Hwy 20 Basin WY 82410-8902 Ph: (307) 568-3311 |
NPI Number | 1811901515 |
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Provider Enumeration Date | 07/28/2006 |
Last Update Date | 10/30/2023 |
Medicare PECOS PAC ID | 1254314107 |
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Medicare Enrollment ID | O20080916000132 |
Identifier | Type | State | Issuer |
---|---|---|---|
1811901515 | NPI | - | NPPES |
110012203 | Medicaid | WY | |
110012205 | Medicaid | WY | |
115069300 | Medicaid | WY | |
BLUE CROSS | Other | WY | 722001 |