Provider Demographics
NPI:1124215553
Name:BIG HORN BASIN PATHOLOGY, PC
Entity Type:Organization
Organization Name:BIG HORN BASIN PATHOLOGY, PC
Other - Org Name:LEE K. HERMANN, MCPC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-587-5802
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:307-587-5802
Mailing Address - Fax:307-587-6041
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:307-587-5802
Practice Address - Fax:307-587-6041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5112A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW4400028Medicare PIN
WYF78945Medicare UPIN