| Sundance Clinic | |
|
713 Oak Street Sundance WY 82729 | |
| (307) 283-3501 | |
| (307) 283-2255 |
| Full Name | Sundance Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 713 Oak Street, Sundance, Wyoming |
| Authorized Official Name and Position | Micki Dahne Lyons (CEO) |
| Authorized Official Contact | 3072833501 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sundance Clinic Po Box 517 713 Oak Street Sundance WY 82729-0517 Ph: (307) 283-3501 | Sundance Clinic 713 Oak Street Sundance WY 82729 Ph: (307) 283-3501 |
| NPI Number | 1245308428 |
|---|---|
| Provider Enumeration Date | 12/04/2006 |
| Last Update Date | 10/16/2020 |
| Medicare PECOS PAC ID | 9234032483 |
|---|---|
| Medicare Enrollment ID | O20120229000661 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245308428 | NPI | - | NPPES |
| 106178006 | Medicaid | WY | |
| 106178004 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Crook County Medical Services District Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 713 Oak Street, Sundance, WY 82729 Phone: 307-283-3501 Fax: 307-283-2255 |