Provider Demographics
NPI:1073254595
Name:WIND RIVER FAMILY & COMMUNITY HEALTH CARE - DIALYSIS CENTER
Entity Type:Organization
Organization Name:WIND RIVER FAMILY & COMMUNITY HEALTH CARE - DIALYSIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-856-9281
Mailing Address - Street 1:PO BOX 1310
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-0158
Mailing Address - Country:US
Mailing Address - Phone:307-856-9281
Mailing Address - Fax:307-463-4489
Practice Address - Street 1:909 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3228
Practice Address - Country:US
Practice Address - Phone:307-856-9281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment