| Volunteers Of America Northern Rockies | |
|
420 1-2 Main St Sundance WY 82729-0646 | |
| (307) 283-3636 | |
| (307) 283-2898 |
| Full Name | Volunteers Of America Northern Rockies |
|---|---|
| Speciality | Clinic/Center |
| Location | 420 1-2 Main St, Sundance, Wyoming |
| Authorized Official Name and Position | Kelly Buckingham (VP OF IT AND COMPLIANCE) |
| Authorized Official Contact | 3076720475 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Volunteers Of America Northern Rockies 521 W Lott St Buffalo WY 82834-1642 Ph: (307) 751-7440 | Volunteers Of America Northern Rockies 420 1-2 Main St Sundance WY 82729-0646 Ph: (307) 283-3636 |
| NPI Number | 1558415927 |
|---|---|
| Provider Enumeration Date | 01/23/2007 |
| Last Update Date | 04/01/2023 |
| Certification Date | 04/01/2023 |
| Medicare PECOS PAC ID | 8921901125 |
|---|---|
| Medicare Enrollment ID | O20040127000709 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558415927 | NPI | - | NPPES |
| 106076706 | Medicaid | WY | |
| 01175001 | Other | WY | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (Wyoming) | Primary |
| Provider Name | Brenda J Engle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639375678 PECOS PAC ID: 8224121637 Enrollment ID: I20170320001418 |
| Provider Name | Sarah Anne Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871987826 PECOS PAC ID: 6002172608 Enrollment ID: I20171115001734 |
| Provider Name | Glenda Springsted Spencer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518050541 PECOS PAC ID: 1153466552 Enrollment ID: I20180530002002 |
| Provider Name | Leslie T Patterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760713903 PECOS PAC ID: 0244620425 Enrollment ID: I20211201002928 |
| Provider Name | Lisa A Foodim |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619968500 PECOS PAC ID: 4880621382 Enrollment ID: I20211216002337 |
| Provider Name | Chad M Lobdell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851798144 PECOS PAC ID: 5991189557 Enrollment ID: I20220830004516 |