Provider Demographics
NPI:1023169778
Name:ROCK SPRINGS FAMILY PRACTICE INC
Entity type:Organization
Organization Name:ROCK SPRINGS FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:POYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:307-362-0083
Mailing Address - Street 1:1208 HILLTOP DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5857
Mailing Address - Country:US
Mailing Address - Phone:307-362-0083
Mailing Address - Fax:307-362-0084
Practice Address - Street 1:1208 HILLTOP DR
Practice Address - Street 2:SUITE 205
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5857
Practice Address - Country:US
Practice Address - Phone:307-362-0083
Practice Address - Fax:307-362-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY123611300Medicaid
WY123611300Medicaid
WYW21041Medicare PIN