Provider Demographics
NPI:1932299740
Name:LARAMIE CLINIC, P.C.
Entity Type:Organization
Organization Name:LARAMIE CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-745-4884
Mailing Address - Street 1:PO BOX 1185
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82073-1185
Mailing Address - Country:US
Mailing Address - Phone:307-745-4884
Mailing Address - Fax:307-745-5207
Practice Address - Street 1:3810 E GRAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5179
Practice Address - Country:US
Practice Address - Phone:307-745-4884
Practice Address - Fax:307-745-5207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY306983Medicare ID - Type Unspecified