Healthcare Provider Details

I. General information

NPI: 1508922568
Provider Name (Legal Business Name): ATWOOD FAMILY FUNERAL DIRECTORS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 WEST C STREET
BASIN WY
82410-0460
US

IV. Provider business mailing address

PO BOX 460 419 WEST C STREET
BASIN WY
82410-0460
US

V. Phone/Fax

Practice location:
  • Phone: 307-568-2041
  • Fax: 307-568-2727
Mailing address:
  • Phone: 307-568-2041
  • Fax: 307-568-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176P00000X
TaxonomyFuneral Director
License Number15
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6
License Number StateWY

VIII. Authorized Official

Name: MR. DELMAR W ATWOOD JR.
Title or Position: PRESIDENT AMBULANCE DIRECTOR FUNERA
Credential:
Phone: 307-568-2041