Provider Demographics
NPI:1477929560
Name:BAR B RANCH & LIVESTOCK
Entity Type:Organization
Organization Name:BAR B RANCH & LIVESTOCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PPC
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-431-7350
Mailing Address - Street 1:3712 ROAD 7
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82411-9738
Mailing Address - Country:US
Mailing Address - Phone:307-431-7350
Mailing Address - Fax:
Practice Address - Street 1:3712 ROAD 7
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WY
Practice Address - Zip Code:82411-9738
Practice Address - Country:US
Practice Address - Phone:307-431-7350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-761251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health