MEDICARE: GORDON MAX MICKELSON III

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1356678270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON MAX MICKELSON III

Provider Business Mailing Address
First Line	:	3508 WHITE MOUNTAIN BLVD
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-6842
Country	:	US
Telephone Number	:	307-389-9169
Fax Number	:

Provider Business Practice Location Address
First Line	:	3508 WHITE MOUNTAIN BLVD
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-6842
Country	:	US
Telephone Number	:	307-389-9169
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2009
Last Update Date	:	11/13/2009

Similar Medicare Providers

1013605641 — YOKO-FRANCOISE FUNK
Practice Location Address:

6842 FALLEN ROCK ST
N LAS VEGAS, NV
89084-2582

Practice Phone: 702-278-7628
Practice Fax:

1023041506 — DIALYSIS CLINIC INC.
Practice Location Address:

2821 WARM SPRINGS RD
COLUMBUS, GA
31904-6842

Practice Phone: 706-323-2415
Practice Fax: 706-323-2564

1770133829 — GLIMMER OF HOPE HOME HEALTH CARE LLP
Practice Location Address:

6842 MESCALERO DR
COLORADO SPRINGS, CO
80915-3110

Practice Phone: 719-331-2610
Practice Fax:

1528874989 — MARIA DEL SAGRARIO PAYARES AREVALO
Practice Location Address:

6842 GOLDCREST CT
COLORADO SPRINGS, CO
80919-1958

Practice Phone: 719-332-5759
Practice Fax:

1790582526 — LISA LAHENEY RN
Practice Location Address:

1500 IRON SPRINGS DR
LAS VEGAS, NV
89144-6842

Practice Phone: 530-391-8216
Practice Fax:

1730730771 — TAMARA SUE WALKER PNP, PMHNP, PMHS
Practice Location Address:

1208 HILLTOP DR STE 103
ROCK SPRINGS, WY
82901-5858

Practice Phone: 307-371-2427
Practice Fax: 307-224-2128

Directions to “ GORDON MAX MICKELSON III ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.