Healthcare Provider Details

I. General information

NPI: 1972421576
Provider Name (Legal Business Name): PG DIRECT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PINE AVE STE 3B
KEMMERER WY
83101
US

IV. Provider business mailing address

30 N GOULD ST STE N
SHERIDAN WY
82801-6317
US

V. Phone/Fax

Practice location:
  • Phone: 307-381-8446
  • Fax: 307-209-5774
Mailing address:
  • Phone: 307-381-8446
  • Fax: 307-209-5774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS J GREEN
Title or Position: OWNER
Credential: NP
Phone: 307-381-8446