Provider Demographics
NPI:1851410682
Name:LARAMIE REPRODUCTIVE HEALTH
Entity Type:Organization
Organization Name:LARAMIE REPRODUCTIVE HEALTH
Other - Org Name:ALBANY COUNTY FAMILY PLANNING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-745-4364
Mailing Address - Street 1:1252 N 22ND ST SUITE A
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072
Mailing Address - Country:US
Mailing Address - Phone:307-745-5364
Mailing Address - Fax:307-745-4164
Practice Address - Street 1:1252 N 22ND ST SUITE A
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072
Practice Address - Country:US
Practice Address - Phone:307-745-5364
Practice Address - Fax:307-745-4164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X
WY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106189500Medicaid
WY106189500Medicaid
WY106189500Medicaid