Provider Demographics
NPI:1083822795
Name:BIG HORN BASIN PATHOLOGY
Entity Type:Organization
Organization Name:BIG HORN BASIN PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:POTTER
Authorized Official - Last Name:ROOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-578-1850
Mailing Address - Street 1:707 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3409
Mailing Address - Country:US
Mailing Address - Phone:307-578-1850
Mailing Address - Fax:307-578-1850
Practice Address - Street 1:1008 CODY AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4118
Practice Address - Country:US
Practice Address - Phone:307-578-1850
Practice Address - Fax:307-578-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory