Provider Demographics
NPI:1326560780
Name:BENESSERE CLINIC LLC
Entity Type:Organization
Organization Name:BENESSERE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-332-6222
Mailing Address - Street 1:195 CAPITOL STREET
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520
Mailing Address - Country:US
Mailing Address - Phone:307-332-6222
Mailing Address - Fax:307-332-6223
Practice Address - Street 1:195 CAPITOL ST.
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520
Practice Address - Country:US
Practice Address - Phone:307-332-6222
Practice Address - Fax:307-332-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty