| Big Horn Pediatrics | |
|
1308 W 4th St Gillette WY 82716-3330 | |
| (307) 687-1300 | |
| (307) 682-1309 |
| Full Name | Big Horn Pediatrics |
|---|---|
| Speciality | Pediatrics |
| Location | 1308 W 4th St, Gillette, Wyoming |
| Authorized Official Name and Position | Ann L Edwards (OFFICE MANAGER) |
| Authorized Official Contact | 3076871300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Big Horn Pediatrics 1308 W 4th St Gillette WY 82716-3330 Ph: (307) 687-1300 | Big Horn Pediatrics 1308 W 4th St Gillette WY 82716-3330 Ph: (307) 687-1300 |
| NPI Number | 1477660447 |
|---|---|
| Provider Enumeration Date | 08/24/2006 |
| Last Update Date | 07/27/2020 |
| Medicare PECOS PAC ID | 3971923137 |
|---|---|
| Medicare Enrollment ID | O20201009001141 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477660447 | NPI | - | NPPES |
| 830306207 | Other | WY | TAX I.D.# |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
| Provider Name | Aubrey D Tabb |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316925456 PECOS PAC ID: 3779644331 Enrollment ID: I20081202000251 |
| Provider Name | Jennifer Alexis Rasmuson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780178897 PECOS PAC ID: 4880005891 Enrollment ID: I20201124000755 |
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