Provider Demographics
NPI:1942347844
Name:SWEETWATER MEDICS LLC
Entity Type:Organization
Organization Name:SWEETWATER MEDICS LLC
Other - Org Name:SWEETWATER MEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:GATTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-371-8833
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-0356
Mailing Address - Country:US
Mailing Address - Phone:307-362-6108
Mailing Address - Fax:307-362-6165
Practice Address - Street 1:916 PILOT BUTTE AVE
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5349
Practice Address - Country:US
Practice Address - Phone:307-362-6108
Practice Address - Fax:307-362-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY315032OtherBC/BS OF WYOMING
WY1942347844Medicaid
WY1942347844Medicaid
WY315032OtherBC/BS OF WYOMING