Provider Demographics
NPI:1871680041
Name:WYOMING RANGE MEDICAL PC
Entity Type:Organization
Organization Name:WYOMING RANGE MEDICAL PC
Other - Org Name:RED DESERT INSTA CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-382-3064
Mailing Address - Street 1:PO BOX 1479
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-1479
Mailing Address - Country:US
Mailing Address - Phone:307-382-3064
Mailing Address - Fax:307-382-3303
Practice Address - Street 1:2761 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4753
Practice Address - Country:US
Practice Address - Phone:307-382-3064
Practice Address - Fax:307-382-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY313591OtherBLUE CROSS BLUE SHIELD
WY313591OtherBLUE CROSS BLUE SHIELD