Provider Demographics
NPI:1700964699
Name:WIND RIVER HEALTH SYSTEMS
Entity Type:Organization
Organization Name:WIND RIVER HEALTH SYSTEMS
Other - Org Name:DUBOIS MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, MBA
Authorized Official - Phone:307-857-6685
Mailing Address - Street 1:511 N. 12TH ST. E
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3809
Mailing Address - Country:US
Mailing Address - Phone:307-857-6685
Mailing Address - Fax:307-857-9927
Practice Address - Street 1:5647 US HWY 26
Practice Address - Street 2:
Practice Address - City:DUBOIS
Practice Address - State:WY
Practice Address - Zip Code:82513-0577
Practice Address - Country:US
Practice Address - Phone:307-455-2516
Practice Address - Fax:307-455-2526
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WIND RIVER HEALTH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY531813Medicare UPIN