Provider Demographics
NPI:1508922568
Name:ATWOOD FAMILY FUNERAL DIRECTORS INC
Entity Type:Organization
Organization Name:ATWOOD FAMILY FUNERAL DIRECTORS INC
Other - Org Name:ATWOOD FAMILY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AMBULANCE DIRECTOR FUNERA
Authorized Official - Prefix:MR
Authorized Official - First Name:DELMAR
Authorized Official - Middle Name:W
Authorized Official - Last Name:ATWOOD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:307-568-2041
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:419 WEST C STREET
Mailing Address - City:BASIN
Mailing Address - State:WY
Mailing Address - Zip Code:82410-0460
Mailing Address - Country:US
Mailing Address - Phone:307-568-2041
Mailing Address - Fax:307-568-2727
Practice Address - Street 1:419 WEST C STREET
Practice Address - Street 2:
Practice Address - City:BASIN
Practice Address - State:WY
Practice Address - Zip Code:82410-0460
Practice Address - Country:US
Practice Address - Phone:307-568-2041
Practice Address - Fax:307-568-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15176P00000X
WY63416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No176P00000XOther Service ProvidersFuneral DirectorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW4500274Medicare PIN