Healthcare Provider Details

I. General information

NPI: 1285612317
Provider Name (Legal Business Name): FAMILY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 WEST LOTT
BUFFALO WY
82834-1609
US

IV. Provider business mailing address

497 WEST LOTT
BUFFALO WY
82834-1609
US

V. Phone/Fax

Practice location:
  • Phone: 307-684-5521
  • Fax: 307-684-5385
Mailing address:
  • Phone: 307-684-5521
  • Fax: 307-684-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KENT WARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 307-684-5521