1558040766 NPI number — HOSKINSON HEALTH & WELLNESS CLINIC, LLC

Table of content: (NPI 1558040766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558040766 NPI number — HOSKINSON HEALTH & WELLNESS CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSKINSON HEALTH & WELLNESS CLINIC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOSKINSON HEALING THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558040766
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 W LAKEWAY ROAD
Provider Second Line Business Mailing Address:
STE 700
Provider Business Mailing Address City Name:
GILLETTE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82718-6346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-387-9850
Provider Business Mailing Address Fax Number:
307-987-9890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 W LAKEWAY ROAD
Provider Second Line Business Practice Location Address:
STE 700
Provider Business Practice Location Address City Name:
GILLETTE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82718-6346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-387-9850
Provider Business Practice Location Address Fax Number:
307-987-9890
Provider Enumeration Date:
07/14/2023

Additional Information

Authorized Official

Authorized Official Last Name:
HOSKINSON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER, CHIEF MEDICAL OFFI
Authorized Official Telephone Number:
307-387-9850

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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