Healthcare Provider Details

I. General information

NPI: 1154342921
Provider Name (Legal Business Name): MEDIHORIZONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 BLUEGRASS CIR SUITE 200
CHEYENNE WY
82009-7323
US

IV. Provider business mailing address

PO BOX 20170
CHEYENNE WY
82003-7004
US

V. Phone/Fax

Practice location:
  • Phone: 307-635-5393
  • Fax: 307-635-2199
Mailing address:
  • Phone: 307-635-5393
  • Fax: 307-635-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DONALD A KOUGL
Title or Position: PRESIDENT
Credential: MD
Phone: 307-635-5393