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General NPI Number Information
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NPI Number | 1295959963
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Entity Type | Organization
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Legal Business Name | WIND RIVER RADIOLOGY P C
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 295 GARFIELD ST
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City | LANDER
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State | WY
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Zip | 82520-3121
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Country | US
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Telephone | 307-335-6451
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Fax | 307-335-6467
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Provider Business Mailing Address
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Address Line | 295 GARFIELD ST
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City | LANDER
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State | WY
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Zip | 82520-3121
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Country | US
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Telephone | 307-332-2357
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Fax | 307-332-4276
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARY E MAGNUSON
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Credential |
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Telephone | 307-332-2357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471C3402X
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Taxonomy Name | Radiography Radiologic Technologist
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License Number |
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License Number State |
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