Healthcare Provider Details

I. General information

NPI: 1841313723
Provider Name (Legal Business Name): REPRODUCTIVE HEALTHCARE OF THE BIG HORNS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 S. THURMOND ST
SHERIDAN WY
82801
US

IV. Provider business mailing address

128 S. THURMOND ST
SHERIDAN WY
82801
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-7054
  • Fax: 307-672-7392
Mailing address:
  • Phone: 307-672-7054
  • Fax: 307-672-7392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number261QA0005X
License Number StateWY

VIII. Authorized Official

Name: MRS. AMANDA BLISH ALEXANDER
Title or Position: CLINICAL COORDINATOR
Credential: RN
Phone: 307-672-7054