MEDICARE: US HEALTH DEPT OF HEALTH & HUMAN SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP0904X	Federal Public Health Clinic/Center

General Provider Information

NPI Number	:	1104976372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	US HEALTH DEPT OF HEALTH & HUMAN SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 1310
Second Line	:	14 GREAT PLAINS RD ARAPAHOE WY 82501
City	:	RIVERTON
State	:	WY
Zip	:	82501-0158
Country	:	US
Telephone Number	:	307-856-9281
Fax Number	:	307-856-1630

Provider Business Practice Location Address
First Line	:	14 GREAT PLAINS ROAD
Second Line	:
City	:	ARAPAHOE
State	:	WY
Zip	:	82501
Country	:	US
Telephone Number	:	307-856-9281
Fax Number	:	307-856-1630

Authorized Official
Title or Position	:	ACTING CEO/ADMINISTRATIVE OFFICER
Name	:	MRS. MICHELLE ANTONE
Credential	:
Telephone Number	:	307-332-7300

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	05/24/2011

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