Healthcare Provider Details

I. General information

NPI: 1053493403
Provider Name (Legal Business Name): MEDCOR OF BARRINGTON, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OLD FAITHFUL HOT SPRINGS
YELLOWSTONE NAT'L PARK WY
82190
US

IV. Provider business mailing address

PO BOX 2058
YELLOWSTONE NATIONAL PARK WY
82190-2058
US

V. Phone/Fax

Practice location:
  • Phone: 307-545-7325
  • Fax: 307-545-7302
Mailing address:
  • Phone: 307-545-7325
  • Fax: 307-545-7302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: THOMAS H. GLIMP
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 815-363-9500