Provider Demographics
NPI:1922213537
Name:ONE22 INC
Entity Type:Organization
Organization Name:ONE22 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-201-8193
Mailing Address - Street 1:PO BOX 1232
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-1232
Mailing Address - Country:US
Mailing Address - Phone:307-739-4500
Mailing Address - Fax:307-739-4505
Practice Address - Street 1:180 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8337
Practice Address - Country:US
Practice Address - Phone:307-739-4500
Practice Address - Fax:307-739-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY123033600Medicaid