Healthcare Provider Details

I. General information

NPI: 1245561323
Provider Name (Legal Business Name): EMG LARAMIE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 N 22ND ST
LARAMIE WY
82072-5303
US

IV. Provider business mailing address

2850 24TH AVE S STE 201
GRAND FORKS ND
58201-5831
US

V. Phone/Fax

Practice location:
  • Phone: 701-738-2000
  • Fax: 701-757-4701
Mailing address:
  • Phone: 701-738-2000
  • Fax: 701-757-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: PHILIP GISI
Title or Position: PRESIDING MEMBER
Credential:
Phone: 701-741-6230