| NPI | 1720310709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARLENE CROSS Accountant 307-333-6910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2010-02-02 |
| Last Update Date | 2019-03-22 |