=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407010853
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L JOANNE HEDGECOCK MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2008
-----------------------------------------------------
Last Update Date | 07/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1025 COLLEGE VIEW DR
-----------------------------------------------------
City | RIVERTON
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82501-2266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-857-2000
-----------------------------------------------------
Fax | 307-857-0339
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1025 COLLEGE VIEW DR
-----------------------------------------------------
City | RIVERTON
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82501-2266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-857-2000
-----------------------------------------------------
Fax | 307-857-0339
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | L JOANNE HEDGECOCK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 307-857-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 3454A
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------