Provider Demographics
NPI:1396216461
Name:CENTRAL WYOMING HOUSECALLS, LLC
Entity Type:Organization
Organization Name:CENTRAL WYOMING HOUSECALLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:307-714-1685
Mailing Address - Street 1:804 GARNER DR
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3512
Mailing Address - Country:US
Mailing Address - Phone:307-714-1685
Mailing Address - Fax:307-335-8873
Practice Address - Street 1:804 GARNER DR
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3512
Practice Address - Country:US
Practice Address - Phone:307-714-1685
Practice Address - Fax:307-335-8873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization