Provider Demographics
NPI:1346700622
Name:WIND RIVER FAMILY & COMMUNITY HEALTH CARE
Entity Type:Organization
Organization Name:WIND RIVER FAMILY & COMMUNITY HEALTH CARE
Other - Org Name:WIND RIVER CARES - ETHETE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-856-9281
Mailing Address - Street 1:PO BOX 1310
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-0158
Mailing Address - Country:US
Mailing Address - Phone:307-856-9281
Mailing Address - Fax:
Practice Address - Street 1:707 BLUE SKY HIGHWAY
Practice Address - Street 2:
Practice Address - City:ETHETE
Practice Address - State:WY
Practice Address - Zip Code:82520
Practice Address - Country:US
Practice Address - Phone:307-855-2751
Practice Address - Fax:307-335-1038
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WIND RIVER FAMILY & COMMUNITY HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-22
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1142138700Medicaid