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NPI Code Detail

MEDICARE: WIND RIVER PEDIATRICS, LLC

MEDICARE: WIND RIVER PEDIATRICS, LLC
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
1208000000XPediatrics Physician7224AWY

General Provider Information

NPI Number : 1215976253
Entity Type Code : Organization
Provider Name (Legal Business Name) : WIND RIVER PEDIATRICS, LLC
Provider Business Mailing Address
First Line : 1005 COLLEGE VIEW DR
Second Line :
City : RIVERTON
State : WY
Zip : 82501-2266
Country : US
Telephone Number : 307-857-5247
Fax Number : 307-857-5215
Provider Business Practice Location Address
First Line : 1005 COLLEGE VIEW DR
Second Line :
City : RIVERTON
State : WY
Zip : 82501-2266
Country : US
Telephone Number : 307-857-5247
Fax Number : 307-857-5215
Authorized Official
Title or Position : CEO
Name : MICHAEL R FISHER
Credential : MD
Telephone Number : 307-857-5247
Provider Enumeration Date : 06/05/2006
Last Update Date : 08/22/2020

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Directions to “WIND RIVER PEDIATRICS, LLC ” Practice Location

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