Healthcare Provider Details

I. General information

NPI: 1902716020
Provider Name (Legal Business Name): HIGH COUNTRY HEALTHWATCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 COUNTY ROAD 164
PINE BLUFFS WY
82082-9518
US

IV. Provider business mailing address

PO BOX 134
PINE BLUFFS WY
82082-0134
US

V. Phone/Fax

Practice location:
  • Phone: 307-630-8421
  • Fax:
Mailing address:
  • Phone: 307-630-8421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: CRAIG JOHNSON
Title or Position: OWNER
Credential:
Phone: 307-630-8421