| NPI | 1154836617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WADE T BOMENGEN Owner 307-347-2449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2017-12-06 |
| Last Update Date | 2018-01-19 |