Provider Demographics
NPI:1003836834
Name:MEDI HORIZONS INC
Entity Type:Organization
Organization Name:MEDI HORIZONS INC
Other - Org Name:HEALTHREACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARLISS
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-635-3500
Mailing Address - Street 1:PO BOX 20170
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7004
Mailing Address - Country:US
Mailing Address - Phone:307-635-5393
Mailing Address - Fax:307-635-2199
Practice Address - Street 1:2030 BLUEGRASS CIR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7328
Practice Address - Country:US
Practice Address - Phone:307-635-3500
Practice Address - Fax:307-635-2199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUEGRASS PROFESSIONAL PLAZA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-21
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106825300Medicaid
WYW4371838Medicare PIN