Provider Demographics
NPI:1922643097
Name:WESTERN WYOMING MEDICAL CLINICS LLC
Entity Type:Organization
Organization Name:WESTERN WYOMING MEDICAL CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-206-1224
Mailing Address - Street 1:PO BOX 26950
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2020
Mailing Address - Country:US
Mailing Address - Phone:307-206-1224
Mailing Address - Fax:307-206-1214
Practice Address - Street 1:535 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3410
Practice Address - Country:US
Practice Address - Phone:307-206-1224
Practice Address - Fax:307-206-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY152503400Medicaid