Healthcare Provider Details

I. General information

NPI: 1497831945
Provider Name (Legal Business Name): WESTERN FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 RIVERVIEW ROAD
RIVERTON WY
82501
US

IV. Provider business mailing address

1620 RIVERVIEW ROAD
RIVERTON WY
82501
US

V. Phone/Fax

Practice location:
  • Phone: 307-856-6591
  • Fax: 307-856-4027
Mailing address:
  • Phone: 307-856-6591
  • Fax: 307-856-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY MARGARET STOCKTON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 307-856-6591