Provider Demographics
NPI:1487756102
Name:MEDICINE BOW RURAL HEALTH CARE DISTRICT
Entity type:Organization
Organization Name:MEDICINE BOW RURAL HEALTH CARE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MA/CPT/EMT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-379-2222
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:514 IDAHO DR
Mailing Address - City:MEDICINE BOW
Mailing Address - State:WY
Mailing Address - Zip Code:82329-0037
Mailing Address - Country:US
Mailing Address - Phone:307-379-2222
Mailing Address - Fax:307-379-2223
Practice Address - Street 1:514 IDAHO DR
Practice Address - Street 2:
Practice Address - City:MEDICINE BOW
Practice Address - State:WY
Practice Address - Zip Code:82329-0037
Practice Address - Country:US
Practice Address - Phone:307-379-2222
Practice Address - Fax:307-379-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106597100Medicaid
WY106597100Medicaid
A73197Medicare UPIN