Provider Demographics
NPI:1215180898
Name:HIGH PERFORMANCE SPORTS MEDICINE PC
Entity Type:Organization
Organization Name:HIGH PERFORMANCE SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:IAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-514-4041
Mailing Address - Street 1:406 S. 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-3603
Mailing Address - Country:US
Mailing Address - Phone:307-514-4041
Mailing Address - Fax:
Practice Address - Street 1:406 S. 2ND STREET
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3603
Practice Address - Country:US
Practice Address - Phone:307-514-4041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7107A207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty