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General NPI Number Information
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NPI Number | 1225331325
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Entity Type | Organization
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Legal Business Name | WYOMING MEDICAL
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Dates
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Enumeration Date | 12/10/2010
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Last Update Date | 12/10/2010
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Provider Practice Location Address
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Address Line | 220 E BROADWAY
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City | JACKSON
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State | WY
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Zip | 83001
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Country | US
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Telephone | 307-413-2087
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Fax | 877-382-7638
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Provider Business Mailing Address
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Address Line | 3060 S BRIDLE DR
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City | JACKSON
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State | WY
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Zip | 83001-9124
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Country | US
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Telephone | 307-413-2087
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Fax | 877-382-7638
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Authorized Official
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Title or Position | PRESIDENT
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Name | REDEEM D SUMICAD
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Credential |
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Telephone | 307-413-2087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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