Provider Demographics
NPI:1497055891
Name:RAMZI T AMMARI PC
Entity Type:Organization
Organization Name:RAMZI T AMMARI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RADONA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BORGIALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-686-7031
Mailing Address - Street 1:1300 W 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3339
Mailing Address - Country:US
Mailing Address - Phone:307-686-7031
Mailing Address - Fax:307-686-3619
Practice Address - Street 1:1300 W 4TH STREET
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3339
Practice Address - Country:US
Practice Address - Phone:307-686-7031
Practice Address - Fax:307-686-3619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5967A207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY187728586Medicaid
WY187728586Medicaid
WYG35914Medicare UPIN