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General NPI Number Information
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NPI Number | 1972421576
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Entity Type | Organization
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Legal Business Name | PG DIRECT CARE LLC
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Dates
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Enumeration Date | 07/09/2026
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Last Update Date | 07/09/2026
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Provider Practice Location Address
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Address Line | 1100 PINE AVE STE 3B
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City | KEMMERER
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State | WY
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Zip | 83101
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Country | US
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Telephone | 307-381-8446
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Fax | 307-209-5774
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Provider Business Mailing Address
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Address Line | 30 N GOULD ST STE N
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City | SHERIDAN
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State | WY
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Zip | 82801-6317
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Country | US
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Telephone | 307-381-8446
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Fax | 307-209-5774
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Authorized Official
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Title or Position | OWNER
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Name | NICHOLAS J GREEN
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Credential | NP
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Telephone | 307-381-8446
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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 |
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License Number State |
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