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General NPI Number Information
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NPI Number | 1629304589
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Entity Type | Organization
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Legal Business Name | BIG HORN BASIN CHILDRENS CLINIC PC
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Dates
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Enumeration Date | 10/28/2009
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 1220 SUNSHINE AVE SUITE 101
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City | CODY
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State | WY
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Zip | 82414
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Country | US
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Telephone | 307-587-5545
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Fax | 307-527-5202
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Provider Business Mailing Address
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Address Line | 1220 SUNSHINE AVE SUITE 101
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City | CODY
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State | WY
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Zip | 82414-4234
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Country | US
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Telephone | 307-587-5545
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Fax | 307-527-5202
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT NEIL TREECE
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Credential | M.D.
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Telephone | 307-587-5545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4038A
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License Number State | WY
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