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NPI Code Detail

MEDICARE: SWEETWATER MEDICS LLC

MEDICARE: SWEETWATER MEDICS 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
13416L0300XLand Ambulance

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1315032OTHERWYBC/BS OF WYOMING
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1942347844
Entity Type Code : Organization
Provider Name (Legal Business Name) : SWEETWATER MEDICS LLC
Provider Business Mailing Address
First Line : PO BOX 356
Second Line :
City : ROCK SPRINGS
State : WY
Zip : 82902-0356
Country : US
Telephone Number : 307-362-6108
Fax Number : 307-362-6165
Provider Business Practice Location Address
First Line : 916 PILOT BUTTE AVE
Second Line :
City : ROCK SPRINGS
State : WY
Zip : 82901-5349
Country : US
Telephone Number : 307-362-6108
Fax Number : 307-362-6165
Authorized Official
Title or Position : DIRECTOR
Name : RONALD G GATTI
Credential :
Telephone Number : 307-371-8833
Provider Enumeration Date : 01/31/2007
Last Update Date : 12/09/2013

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Directions to “SWEETWATER MEDICS LLC ” Practice Location

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