Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 525 N 5th Street, Basin, Wyoming |
Authorized Official Name and Position | Hannah Hannah Mcrae (CFO) |
Authorized Official Contact | 3075782490 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
707 Sheridan Ave Cody WY 82414-3409 Ph: (307) 527-7501 | 525 N 5th Street Basin WY 82410 Ph: (307) 527-7501 |
NPI Number | 1942921937 |
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Provider Enumeration Date | 09/07/2022 |
Last Update Date | 03/15/2024 |
Medicare PECOS PAC ID | 7315855624 |
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Medicare Enrollment ID | O20230119002906 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942921937 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |