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General NPI Number Information
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NPI Number | 1770536963
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Entity Type | Organization
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Legal Business Name | THURSTON MEDICAL CLINIC PC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 401 S 15TH ST
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City | WORLAND
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State | WY
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Zip | 82401-3530
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Country | US
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Telephone | 307-347-2525
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Fax | 307-347-3949
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Provider Business Mailing Address
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Address Line | 401 S 15TH ST
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City | WORLAND
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State | WY
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Zip | 82401-3530
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Country | US
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Telephone | 307-347-2525
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Fax | 307-347-3949
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN E THURSTON
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Credential | MD
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Telephone | 307-347-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5442A
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License Number State | WY
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