Provider Demographics
NPI:1427545938
Name:FIVE SPRINGS HEALTH AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:FIVE SPRINGS HEALTH AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:307-764-5470
Mailing Address - Street 1:246 N ABSAROKA ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2331
Mailing Address - Country:US
Mailing Address - Phone:307-764-5470
Mailing Address - Fax:307-764-5471
Practice Address - Street 1:246 N ABSAROKA ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2331
Practice Address - Country:US
Practice Address - Phone:307-272-4284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty