Healthcare Provider Details

I. General information

NPI: 1942083670
Provider Name (Legal Business Name): HOSKINSON HEALTH & WELLNESS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 HWY 50
GILLETTE WY
82718-9330
US

IV. Provider business mailing address

469 HWY 50
GILLETTE WY
82718-9330
US

V. Phone/Fax

Practice location:
  • Phone: 307-387-9850
  • Fax: 307-387-9890
Mailing address:
  • Phone: 307-387-9850
  • Fax: 307-387-9890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM HOSKINSON
Title or Position: PRESIDENT/OWNER, CHIEF MEDICAL OFFI
Credential: D.O.
Phone: 307-387-9850