Provider Demographics
NPI:1750457933
Name:STRONG TREE CLINIC
Entity Type:Organization
Organization Name:STRONG TREE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMSTARCK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:307-548-6289
Mailing Address - Street 1:342 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-2136
Mailing Address - Country:US
Mailing Address - Phone:307-548-6289
Mailing Address - Fax:307-548-6910
Practice Address - Street 1:342 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOVELL
Practice Address - State:WY
Practice Address - Zip Code:82431-2136
Practice Address - Country:US
Practice Address - Phone:307-548-6289
Practice Address - Fax:307-548-6910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5460A261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY114619001Medicaid
WY114619001Medicaid
WYF16971Medicare UPIN