Provider Demographics
NPI:1609896455
Name:URGENT CARE OF WYOMING INC.
Entity Type:Organization
Organization Name:URGENT CARE OF WYOMING INC.
Other - Org Name:GILLETTE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHERSHOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-388-9299
Mailing Address - Street 1:2007 S DOUGLAS HWY
Mailing Address - Street 2:SUITE E2
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5400
Mailing Address - Country:US
Mailing Address - Phone:307-686-5750
Mailing Address - Fax:307-686-5748
Practice Address - Street 1:2007 S DOUGLAS HWY
Practice Address - Street 2:E2
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5400
Practice Address - Country:US
Practice Address - Phone:307-686-5750
Practice Address - Fax:307-686-5748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY119768100Medicaid
WY01188001OtherBLUE CROSS GROUP NUMBER
WY119768100Medicaid