Healthcare Provider Details

I. General information

NPI: 1932422375
Provider Name (Legal Business Name): WIND RIVER HEALTH SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5647 US HWY 26 DUBOIS MEDICAL CLINIC
DUBOIS WY
82513-3809
US

IV. Provider business mailing address

511 N. 12TH ST E WIND RIVER HEALTH SYSTEMS, INC.
RIVERTON WY
82501-3809
US

V. Phone/Fax

Practice location:
  • Phone: 307-455-2516
  • Fax: 307-455-2526
Mailing address:
  • Phone: 307-857-6685
  • Fax: 307-857-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DONNA KAREN ANDERSEN
Title or Position: BUSINESS DEVELOPMENT COORDINATOR
Credential:
Phone: 307-857-6685