Provider Demographics
NPI:1336315779
Name:ACCESS HEALTH CARE - LLC
Entity Type:Organization
Organization Name:ACCESS HEALTH CARE - LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLOOMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-426-4673
Mailing Address - Street 1:PO BOX 21004
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7020
Mailing Address - Country:US
Mailing Address - Phone:307-426-4673
Mailing Address - Fax:307-426-4674
Practice Address - Street 1:3100 HENDERSON DR
Practice Address - Street 2:SUITE 9
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5846
Practice Address - Country:US
Practice Address - Phone:307-426-4673
Practice Address - Fax:307-426-4674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center