Healthcare Provider Details

I. General information

NPI: 1538200761
Provider Name (Legal Business Name): HUNTER FAMILY MEDICAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 COMMERCIAL WAY
ROCK SPRINGS WY
82901
US

IV. Provider business mailing address

2751 COMMERCIAL WAY
ROCK SPRINGS WY
82901
US

V. Phone/Fax

Practice location:
  • Phone: 307-382-7414
  • Fax: 307-382-7396
Mailing address:
  • Phone: 307-382-7414
  • Fax: 307-382-7396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6113A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLIA53D0972961
License Number StateWY

VIII. Authorized Official

Name: KURT LEROY HUNTER
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 307-382-7414