Healthcare Provider Details

I. General information

NPI: 1104032416
Provider Name (Legal Business Name): URGENT CARE OF JACKSON HOLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 SOUTH HIGHWAY 89
JACKSON WY
83001
US

IV. Provider business mailing address

PO BOX 8640
JACKSON WY
83002-8640
US

V. Phone/Fax

Practice location:
  • Phone: 307-739-8999
  • Fax:
Mailing address:
  • Phone: 307-739-8999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5551A
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number5551A
License Number StateWY

VIII. Authorized Official

Name: DR. FRANKLIN MUSSER RIVERS JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 307-739-8999