| Community Action Of Laramie County, Inc | |
|
1700 Westland Rd Cheyenne WY 82001-3322 | |
| (307) 635-9291 | |
| (307) 632-6131 |
| Full Name | Community Action Of Laramie County, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1700 Westland Rd, Cheyenne, Wyoming |
| Authorized Official Name and Position | Sara Jane Vigil (PROGRAM DIRECTOR) |
| Authorized Official Contact | 3072743010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Action Of Laramie County, Inc Po Box 106 Cheyenne WY 82003-0106 Ph: (307) 635-9291 | Community Action Of Laramie County, Inc 1700 Westland Rd Cheyenne WY 82001-3322 Ph: (307) 635-9291 |
| NPI Number | 1043436983 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 04/14/2025 |
| Medicare PECOS PAC ID | 4385792555 |
|---|---|
| Medicare Enrollment ID | O20151222001392 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043436983 | NPI | - | NPPES |
| 231923300 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 20234.0234 (Wyoming) | Primary |
| Provider Name | Jennifer A Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831660430 PECOS PAC ID: 8426391848 Enrollment ID: I20190528000582 |
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