| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 711 Onyx St, Kemmerer, Wyoming |
| Authorized Official Name and Position | Karl E Sundberg (CEO) |
| Authorized Official Contact | 3078774401 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
711 Onyx St Kemmerer WY 83101-3214 Ph: (307) 877-4401 | 711 Onyx St Kemmerer WY 83101 Ph: (307) 877-4401 |
| NPI Number | 1386716710 |
|---|---|
| Provider Enumeration Date | 11/14/2006 |
| Last Update Date | 03/03/2020 |
| Medicare PECOS PAC ID | 2961490057 |
|---|---|
| Medicare Enrollment ID | O20190904002513 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386716710 | NPI | - | NPPES |
| 00943001 | Other | WY | BLUE CROSS |
| 106769901 | Medicaid | WY | |
| 830267172A001 | Other | WY | CHAMPUS |
| 830267172002 | Other | WY | WORKER'S COMP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 06-148 (Wyoming) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
High Country Behavioral Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 821 Sage Ave, Kemmerer, WY 83101 Phone: 307-877-4466 Fax: 307-789-9832 | |
South Lincoln Hospital District Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 711 Onyx St, Kemmerer, WY 83101 Phone: 307-877-4401 Fax: 307-877-3236 | |