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General NPI Number Information
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NPI Number | 1326560780
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Entity Type | Organization
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Legal Business Name | BENESSERE CLINIC LLC
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Dates
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Enumeration Date | 07/07/2017
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Last Update Date | 07/07/2017
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Provider Practice Location Address
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Address Line | 195 CAPITOL ST.
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City | LANDER
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State | WY
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Zip | 82520
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Country | US
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Telephone | 307-332-6222
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Fax | 307-332-6223
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Provider Business Mailing Address
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Address Line | 195 CAPITOL STREET
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City | LANDER
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State | WY
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Zip | 82520
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Country | US
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Telephone | 307-332-6222
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Fax | 307-332-6223
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Authorized Official
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Title or Position | OWNER
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Name | ANTHONY LOWHAM
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Credential | MD
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Telephone | 307-332-6222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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