| Eastern Shoshone Tribe | |
|
29 Black Coal Dr Fort Washakie WY 82514 | |
| (307) 332-7300 | |
| Not Available |
| Full Name | Eastern Shoshone Tribe |
|---|---|
| Speciality | Clinic/Center |
| Location | 29 Black Coal Dr, Fort Washakie, Wyoming |
| Authorized Official Name and Position | Catherine E Keene (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3073355912 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastern Shoshone Tribe Po Box 128 Fort Washakie WY 82514-0128 Ph: (307) 332-2027 | Eastern Shoshone Tribe 29 Black Coal Dr Fort Washakie WY 82514 Ph: (307) 332-7300 |
| NPI Number | 1770328718 |
|---|---|
| Provider Enumeration Date | 07/01/2024 |
| Last Update Date | 04/22/2025 |
| Medicare PECOS PAC ID | 7810422193 |
|---|---|
| Medicare Enrollment ID | O20241122002799 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770328718 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP0904X | Clinic/center - Public Health, Federal | (* (Not Available)) | Primary |
| Provider Name | Mark S Cardinal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508931981 PECOS PAC ID: 0547384604 Enrollment ID: I20100826000998 |
| Provider Name | Marc D Mclaughlin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164726766 PECOS PAC ID: 2860671666 Enrollment ID: I20190923001237 |
| Provider Name | Juliana E Ike |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801363643 PECOS PAC ID: 1153651559 Enrollment ID: I20190927001777 |
Us Health Dept Of Health & Human Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: Black Coal Drive, #29, Fort Washakie, WY 82514 Phone: 307-332-7300 Fax: 307-332-7464 | |
Indian Health Service Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: Bldg. 29 Black Coal Drive, Fort Washakie, WY 82514 Phone: 307-332-7300 Fax: 307-332-3931 | |
Wind River Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 29 Black Coal Drive, Fort Washakie, WY 82514 Phone: 307-332-0446 Fax: 307-332-0131 | |
Phs Indian Health Service Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 29 Black Coal Drive, Fort Washakie, WY 82514 Phone: 307-332-7300 Fax: 307-332-5753 |