Healthcare Provider Details

I. General information

NPI: 1346700622
Provider Name (Legal Business Name): WIND RIVER FAMILY & COMMUNITY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 BLUE SKY HIGHWAY
ETHETE WY
82520
US

IV. Provider business mailing address

PO BOX 1310
RIVERTON WY
82501-0158
US

V. Phone/Fax

Practice location:
  • Phone: 307-855-2751
  • Fax: 307-335-1038
Mailing address:
  • Phone: 307-856-9281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: KERRIE MINICK
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 307-856-9281