| NPI | 1942571807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY M KLEEMAN Executive Assistant 307-885-9883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0401X Family Medicine, Addiction Medicine | |
| 291U00000X Clinical Medical Laboratory | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2022-06-08 |