Provider Demographics
NPI:1922331321
Name:CAROLINE ESTAY
Entity Type:Organization
Organization Name:CAROLINE ESTAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:CROFT
Authorized Official - Last Name:ESTAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-203-0555
Mailing Address - Street 1:PO BOX 9253
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-9253
Mailing Address - Country:US
Mailing Address - Phone:307-203-0555
Mailing Address - Fax:
Practice Address - Street 1:436 FOREST VIEW DR
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5255
Practice Address - Country:US
Practice Address - Phone:307-203-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management