Healthcare Provider Details

I. General information

NPI: 1659537694
Provider Name (Legal Business Name): CEDAR HILLS FAMILY CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 PINE STREET
UPTON WY
82730
US

IV. Provider business mailing address

PO BOX 676
UPTON WY
82730-0676
US

V. Phone/Fax

Practice location:
  • Phone: 307-468-2302
  • Fax: 307-468-2601
Mailing address:
  • Phone: 307-468-2302
  • Fax: 307-468-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LANNY BRUCE REIMER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 307-468-2302