Healthcare Provider Details

I. General information

NPI: 1881901601
Provider Name (Legal Business Name): CAMEL COUNTRY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 W 4TH ST SUITE 2
GILLETTE WY
82716-3300
US

IV. Provider business mailing address

1206 W 4TH ST SUITE 2
GILLETTE WY
82716-3300
US

V. Phone/Fax

Practice location:
  • Phone: 307-685-3733
  • Fax:
Mailing address:
  • Phone: 307-685-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LORI E MCKINSEY
Title or Position: CO-OWNER
Credential: FNP-C
Phone: 307-685-3733