Provider Demographics
NPI:1386840429
Name:WINDY CITY WELLNESS PC
Entity Type:Organization
Organization Name:WINDY CITY WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PURIFOY
Authorized Official - Suffix:
Authorized Official - Credentials:FNPC
Authorized Official - Phone:307-634-6095
Mailing Address - Street 1:7202 WILLSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-2748
Mailing Address - Country:US
Mailing Address - Phone:307-635-4578
Mailing Address - Fax:
Practice Address - Street 1:403 STOREY BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-3560
Practice Address - Country:US
Practice Address - Phone:307-634-6095
Practice Address - Fax:307-634-9198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY20058Medicare ID - Type Unspecified
WYQ32246Medicare UPIN