| Rising Phoenix Solutions Wyoming Llc | |
|
2321 Dunn Ave Cheyenne WY 82001-3214 | |
| (307) 314-2319 | |
| Not Available |
| Full Name | Rising Phoenix Solutions Wyoming Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2321 Dunn Ave, Cheyenne, Wyoming |
| Authorized Official Name and Position | Kirbie Brown (OWNER) |
| Authorized Official Contact | 3073142319 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rising Phoenix Solutions Wyoming Llc 1623 Central Ave Ste 202 Cheyenne WY 82001-4531 Ph: () - | Rising Phoenix Solutions Wyoming Llc 2321 Dunn Ave Cheyenne WY 82001-3214 Ph: (307) 314-2319 |
| NPI Number | 1376147876 |
|---|---|
| Provider Enumeration Date | 11/24/2020 |
| Last Update Date | 11/29/2022 |
| Certification Date | 11/29/2022 |
| Medicare PECOS PAC ID | 9335582766 |
|---|---|
| Medicare Enrollment ID | O20240213001199 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376147876 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Kirbie L Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609410547 PECOS PAC ID: 6507218567 Enrollment ID: I20240213001291 |
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