Healthcare Provider Details

I. General information

NPI: 1801209655
Provider Name (Legal Business Name): RICHARD WAYNE FREEEMAN BS MT(ASCP)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 6TH AVE NORTH
WOLF POINT MT
59201-0729
US

IV. Provider business mailing address

550 6TH AVE NORTH P.O. BOX 729
WOLF POINT MT
59201-0729
US

V. Phone/Fax

Practice location:
  • Phone: 406-653-1641
  • Fax: 406-653-3728
Mailing address:
  • Phone: 406-653-1641
  • Fax: 406-653-3728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number190326
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: