Healthcare Provider Details

I. General information

NPI: 1821149535
Provider Name (Legal Business Name): CITY OF PINE BLUFFS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MAIN STREET
PINE BLUFFS WY
82082-0429
US

IV. Provider business mailing address

PO BOX 641880
OMAHA NE
68164-7880
US

V. Phone/Fax

Practice location:
  • Phone: 307-245-3746
  • Fax:
Mailing address:
  • Phone: 402-572-4019
  • Fax: 402-965-8594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number63
License Number StateWY

VIII. Authorized Official

Name: SHANNON R WELLER
Title or Position: DIRECTOR
Credential:
Phone: 307-245-3400