| NPI | 1922643097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGETT HOWARD Billing Office 307-206-1224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207L00000X Anesthesiology |
| Enumeration Date | 2019-11-13 |
| Last Update Date | 2021-06-25 |