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General NPI Number Information
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NPI Number | 1598942138
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Entity Type | Organization
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Legal Business Name | COAL COUNTRY CLINIC, LLC
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 1206 W 4TH ST SUITE 2
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City | GILLETTE
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State | WY
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Zip | 82716-3300
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Country | US
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Telephone | 307-682-3004
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Fax | 307-682-3558
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Provider Business Mailing Address
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Address Line | 1206 W 4TH ST SUITE 2
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City | GILLETTE
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State | WY
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Zip | 82716-3300
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Country | US
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Telephone | 307-682-3004
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Fax | 307-682-3558
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Authorized Official
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Title or Position | FNP-C
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Name | LORI MCKINSEY
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Credential | FNP-C
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Telephone | 307-682-3004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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