Provider Demographics
NPI:1922242353
Name:WELLNESS SCREENING
Entity Type:Organization
Organization Name:WELLNESS SCREENING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MT ASCP
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-235-6004
Mailing Address - Street 1:1988 E 1ST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2747
Mailing Address - Country:US
Mailing Address - Phone:307-235-6004
Mailing Address - Fax:307-235-6009
Practice Address - Street 1:1988 E 1ST ST
Practice Address - Street 2:SUITE A
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2747
Practice Address - Country:US
Practice Address - Phone:307-235-6004
Practice Address - Fax:307-235-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service