Provider Demographics
NPI:1407010853
Name:L JOANNE HEDGECOCK MD PC
Entity Type:Organization
Organization Name:L JOANNE HEDGECOCK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:HEDGECOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-857-2000
Mailing Address - Street 1:1025 COLLEGE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-2266
Mailing Address - Country:US
Mailing Address - Phone:307-857-2000
Mailing Address - Fax:307-857-0339
Practice Address - Street 1:1025 COLLEGE VIEW DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2266
Practice Address - Country:US
Practice Address - Phone:307-857-2000
Practice Address - Fax:307-857-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3454A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107146700Medicaid
WI2347OtherBLUE CROSS-BLUE SHIELD
WYA73038Medicare UPIN
WY302347Medicare PIN