Provider Demographics
NPI:1932348414
Name:COWBOY KIDS PEDIATRICS
Entity Type:Organization
Organization Name:COWBOY KIDS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RUTH ANNE
Authorized Official - Middle Name:SMREKAR
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-699-0932
Mailing Address - Street 1:PO BOX 4755
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-4755
Mailing Address - Country:US
Mailing Address - Phone:307-734-0242
Mailing Address - Fax:307-734-8477
Practice Address - Street 1:5237 HHR RANCH RD STE 1
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83014-9220
Practice Address - Country:US
Practice Address - Phone:307-203-5035
Practice Address - Fax:949-655-6058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7622A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty