Provider Demographics
NPI:1740625854
Name:SPRUCE MEDICAL CLINIC
Entity type:Organization
Organization Name:SPRUCE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP QUALITY & COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:KARRAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-324-8383
Mailing Address - Street 1:1016 W SPRUCE ST
Mailing Address - Street 2:P.O. BOX 460
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5371
Mailing Address - Country:US
Mailing Address - Phone:307-321-2221
Mailing Address - Fax:307-324-8232
Practice Address - Street 1:1016 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5371
Practice Address - Country:US
Practice Address - Phone:307-321-2221
Practice Address - Fax:307-324-8232
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL OF CARBON COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty