1932422375 NPI number — WIND RIVER HEALTH SYSTEMS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932422375 NPI number — WIND RIVER HEALTH SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WIND RIVER HEALTH SYSTEMS, INC.
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:
DUBOIS MEDICAL CLINIC
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:
1932422375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 N. 12TH ST E
Provider Second Line Business Mailing Address:
WIND RIVER HEALTH SYSTEMS, INC.
Provider Business Mailing Address City Name:
RIVERTON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82501-3809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-857-6685
Provider Business Mailing Address Fax Number:
307-857-9927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5647 US HWY 26
Provider Second Line Business Practice Location Address:
DUBOIS MEDICAL CLINIC
Provider Business Practice Location Address City Name:
DUBOIS
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82513-3809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-455-2516
Provider Business Practice Location Address Fax Number:
307-455-2526
Provider Enumeration Date:
03/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSEN
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
KAREN
Authorized Official Title or Position:
BUSINESS DEVELOPMENT COORDINATOR
Authorized Official Telephone Number:
307-857-6685

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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