Provider Demographics
NPI:1205382819
Name:STAGECOACH HEALTH PC
Entity Type:Organization
Organization Name:STAGECOACH HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:307-380-3058
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:BAGGS
Mailing Address - State:WY
Mailing Address - Zip Code:82321-0037
Mailing Address - Country:US
Mailing Address - Phone:307-380-3058
Mailing Address - Fax:
Practice Address - Street 1:511 OSBORNE ST.
Practice Address - Street 2:
Practice Address - City:BAGGS
Practice Address - State:WY
Practice Address - Zip Code:82321
Practice Address - Country:US
Practice Address - Phone:307-380-3058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care