Healthcare Provider Details

I. General information

NPI: 1073254595
Provider Name (Legal Business Name): WIND RIVER FAMILY & COMMUNITY HEALTH CARE - DIALYSIS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 W MAIN ST
RIVERTON WY
82501-3228
US

IV. Provider business mailing address

PO BOX 1310
RIVERTON WY
82501-0158
US

V. Phone/Fax

Practice location:
  • Phone: 307-856-9281
  • Fax:
Mailing address:
  • Phone: 307-856-9281
  • Fax: 307-463-4489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD B BRANNAN
Title or Position: CEO
Credential:
Phone: 307-856-9281