Provider Demographics
NPI:1659537694
Name:CEDAR HILLS FAMILY CLINIC, P.C.
Entity Type:Organization
Organization Name:CEDAR HILLS FAMILY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANNY
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:REIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-468-2302
Mailing Address - Street 1:PO BOX 676
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:WY
Mailing Address - Zip Code:82730-0676
Mailing Address - Country:US
Mailing Address - Phone:307-468-2302
Mailing Address - Fax:307-468-2601
Practice Address - Street 1:717 PINE STREET
Practice Address - Street 2:
Practice Address - City:UPTON
Practice Address - State:WY
Practice Address - Zip Code:82730
Practice Address - Country:US
Practice Address - Phone:307-468-2302
Practice Address - Fax:307-468-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
533807Medicare Oscar/Certification