Provider Demographics
NPI:1437323334
Name:JOSEPH J. OLIVER MD,PC
Entity Type:Organization
Organization Name:JOSEPH J. OLIVER MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PC
Authorized Official - Phone:307-362-7745
Mailing Address - Street 1:1204 HILLTOP DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5861
Mailing Address - Country:US
Mailing Address - Phone:307-362-7745
Mailing Address - Fax:307-382-6615
Practice Address - Street 1:1204 HILLTOP DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5861
Practice Address - Country:US
Practice Address - Phone:307-362-7745
Practice Address - Fax:307-382-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2629A207XX0005X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106379101OtherMEDICAID SUPPLY NUMBER
WY106379100Medicaid
WY106379101OtherMEDICAID SUPPLY NUMBER
WY0665620001Medicare NSC
WY301417Medicare PIN