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General NPI Number Information
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NPI Number | 1982420311
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Entity Type | Organization
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Legal Business Name | PRATER MOUNTAIN HEALTH CLINIC
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 118 S MAIN ST SUITE 400
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City | THAYNE
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State | WY
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Zip | 83127
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Country | US
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Telephone | 307-883-7246
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Fax | 307-883-7247
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Provider Business Mailing Address
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Address Line | PO BOX 1179
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City | THAYNE
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State | WY
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Zip | 83127-1179
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Country | US
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Telephone | 307-883-7246
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Fax | 307-883-7247
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DARNELL SIMPSON
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Credential | DC
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Telephone | 307-883-7246
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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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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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