MEDICARE: MICHAEL D. ADAMS, M.D., P.C.

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	207Q00000X	Family Medicine Physician	4371-A	WY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	080014492	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0004116106	OTHER		AETNA
2	02902001	OTHER	WY	BLUECROSS/BLUESHIELD
4	C12604	OTHER		UPIN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	53D0977203	OTHER	WY	CLIA

General Provider Information

NPI Number	:	1205013455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL D. ADAMS, M.D., P.C.

Provider Business Mailing Address
First Line	:	75 YELLOW CREEK RD
Second Line	:	SUITE 102
City	:	EVANSTON
State	:	WY
Zip	:	82930-5235
Country	:	US
Telephone Number	:	307-789-8290
Fax Number	:	307-789-8290

Provider Business Practice Location Address
First Line	:	75 YELLOW CREEK RD
Second Line	:	SUITE 102
City	:	EVANSTON
State	:	WY
Zip	:	82930-5235
Country	:	US
Telephone Number	:	307-789-8290
Fax Number	:	307-789-8290

Authorized Official
Title or Position	:	OPERATIONS SUPERVISOR
Name	:	NIKKI OLDHAM
Credential	:
Telephone Number	:	435-755-6061

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	10/25/2011

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Directions to “MICHAEL D. ADAMS, M.D., P.C. ” Practice Location

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