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General NPI Number Information
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NPI Number | 1083822795
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Entity Type | Organization
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Legal Business Name | BIG HORN BASIN PATHOLOGY
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1008 CODY AVE
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City | CODY
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State | WY
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Zip | 82414-4118
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Country | US
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Telephone | 307-578-1850
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Fax | 307-578-1850
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Provider Business Mailing Address
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Address Line | 707 SHERIDAN AVE
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City | CODY
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State | WY
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Zip | 82414-3409
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Country | US
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Telephone | 307-578-1850
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Fax | 307-578-1850
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Authorized Official
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Title or Position | PATHOLOGIST OWNER
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Name | DR. PAMELA POTTER ROOT
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Credential | MD
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Telephone | 307-578-1850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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