| NPI | 1245605344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDITH ANN PREWITT Provider 307-265-8298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2015-12-01 |