| NPI | 1699292391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD B BRANNAN CEO 307-856-9281 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP0904X Clinic/Center Public Health, Federal |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2024-05-03 |