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General NPI Number Information
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NPI Number | 1801118740
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Entity Type | Organization
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Legal Business Name | WIND RIVER HEALTH CENTER
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Dates
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Enumeration Date | 02/19/2010
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Last Update Date | 10/26/2018
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Provider Practice Location Address
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Address Line | 29 BLACK COAL DRIVE
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City | FORT WASHAKIE
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State | WY
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Zip | 82514-0128
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Country | US
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Telephone | 307-332-0446
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Fax | 307-332-0131
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Provider Business Mailing Address
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Address Line | PO BOX 28 29 BLACK COAL DR
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City | FORT WASHAKIE
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State | WY
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Zip | 82514-0128
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Country | US
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Telephone | 307-332-0446
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Fax | 307-332-0131
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Authorized Official
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Title or Position | CFO
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Name | KIMBERLY JO NOT AFRAID
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Credential |
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Telephone | 307-335-5941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 19363
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License Number State | WY
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