Provider Demographics
NPI:1508970641
Name:FAMILY FIRST, P. C.
Entity Type:Organization
Organization Name:FAMILY FIRST, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:307-778-3675
Mailing Address - Street 1:5416 EDUCATION DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4094
Mailing Address - Country:US
Mailing Address - Phone:307-778-3675
Mailing Address - Fax:307-632-3302
Practice Address - Street 1:5416 EDUCATION DR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4094
Practice Address - Country:US
Practice Address - Phone:307-778-3675
Practice Address - Fax:307-632-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107039800Medicaid
WY00847-00OtherBCBS
CI8929OtherRR MEDICARE
WY107039800Medicaid