Provider Demographics
NPI:1073953287
Name:WYOMING HEALTH COUNCIL
Entity Type:Organization
Organization Name:WYOMING HEALTH COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-632-3640
Mailing Address - Street 1:416 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3523
Mailing Address - Country:US
Mailing Address - Phone:307-632-3640
Mailing Address - Fax:307-362-3611
Practice Address - Street 1:615 E 7TH ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-1643
Practice Address - Country:US
Practice Address - Phone:307-574-5252
Practice Address - Fax:307-754-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY531808Medicare PIN