| Pine Bluffs Clinic | |
|
117 E 4th St Pine Bluffs WY 82082 | |
| (307) 245-3666 | |
| Not Available |
| Full Name | Pine Bluffs Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 117 E 4th St, Pine Bluffs, Wyoming |
| Authorized Official Name and Position | Ronald Malm (PROGRAM DIRECTOR) |
| Authorized Official Contact | 3076322434 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Bluffs Clinic 820 E 17th St Cheyenne WY 82001-4714 Ph: (307) 245-3666 | Pine Bluffs Clinic 117 E 4th St Pine Bluffs WY 82082 Ph: (307) 245-3666 |
| NPI Number | 1316340417 |
|---|---|
| Provider Enumeration Date | 10/02/2014 |
| Last Update Date | 04/13/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316340417 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Pine Bluffs Khs Health Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 117 E 4th St, Pine Bluffs, WY 82082 Phone: 307-245-3666 Fax: 307-245-3656 |