Provider Demographics
NPI:1639617061
Name:UNIVERSITY OF WYOMING
Entity Type:Organization
Organization Name:UNIVERSITY OF WYOMING
Other - Org Name:ALBANY COMMUNITY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-766-3313
Mailing Address - Street 1:2710 HARNEY ST STE 202
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2899
Mailing Address - Country:US
Mailing Address - Phone:307-766-3313
Mailing Address - Fax:307-766-3316
Practice Address - Street 1:2710 HARNEY ST STE 202
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2899
Practice Address - Country:US
Practice Address - Phone:307-766-3313
Practice Address - Fax:307-766-3316
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF WYOMING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-06
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty