MEDICARE: MINDY RAE POMEROY MT

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	246QM0706X	Medical Technologist	227774	MT

General Provider Information

NPI Number	:	1477893253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINDY RAE POMEROY MT

Provider Business Mailing Address
First Line	:	14 GREAT PLAINS ROAD
Second Line	:
City	:	ARAPAHO
State	:	WY
Zip	:	82510
Country	:	US
Telephone Number	:	307-855-2972
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 GREAT PLAINS RD.
Second Line	:
City	:	ARAPAHO
State	:	WY
Zip	:	82510
Country	:	US
Telephone Number	:	307-855-2972
Fax Number	:

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

Provider Enumeration Date	:	02/15/2013
Last Update Date	:	02/15/2013

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