Provider Demographics
NPI:1700900719
Name:CEDAR HILLS FAMILY CLINIC, P.C.
Entity Type:Organization
Organization Name:CEDAR HILLS FAMILY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANNY
Authorized Official - Middle Name:B
Authorized Official - Last Name:REIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-746-3582
Mailing Address - Street 1:1121 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-2968
Mailing Address - Country:US
Mailing Address - Phone:307-746-3582
Mailing Address - Fax:307-746-9744
Practice Address - Street 1:1121 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-2968
Practice Address - Country:US
Practice Address - Phone:307-746-3582
Practice Address - Fax:307-746-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW4371144Medicare PIN
WY533806Medicare Oscar/Certification