| 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 | Andrew Mcalpin (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 | 07/14/2025 |
| 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 | Jenaneta S Hampton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396817516 PECOS PAC ID: 2769546472 Enrollment ID: I20091202000233 |
| Provider Name | Mark S Cardinal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508931981 PECOS PAC ID: 0547384604 Enrollment ID: I20100826000998 |
| Provider Name | Chad J Krezelok |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1285799650 PECOS PAC ID: 6709167638 Enrollment ID: I20180108000405 |
| Provider Name | Kim L Wilde |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891744140 PECOS PAC ID: 3375686173 Enrollment ID: I20190123000471 |
| 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 |
| Provider Name | Himabindu Borra |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1710936596 PECOS PAC ID: 4981848983 Enrollment ID: I20200327002098 |
| Provider Name | Nisha J Manek |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1437139151 PECOS PAC ID: 4486798097 Enrollment ID: I20200401001340 |
| Provider Name | Adam Peterson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033539937 PECOS PAC ID: 9436378734 Enrollment ID: I20200406003274 |
| Provider Name | Peter J Lloyd |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1962717918 PECOS PAC ID: 2769775568 Enrollment ID: I20200407003506 |
| Provider Name | Wanda Shao |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407292857 PECOS PAC ID: 5092084673 Enrollment ID: I20200513000610 |
| Provider Name | Kenna Kennedy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073167953 PECOS PAC ID: 3173937844 Enrollment ID: I20210121001245 |
| Provider Name | Collin Block |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982231510 PECOS PAC ID: 2567886575 Enrollment ID: I20210202002537 |
| Provider Name | Adrienne Highhouse |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609459106 PECOS PAC ID: 0941694905 Enrollment ID: I20220308002267 |
| Provider Name | Sheila Middagh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164076741 PECOS PAC ID: 7618206756 Enrollment ID: I20230221001861 |
| Provider Name | Amy Shah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912169442 PECOS PAC ID: 1557518552 Enrollment ID: I20231009000299 |
| Provider Name | Amanda Kinley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831718642 PECOS PAC ID: 8123443215 Enrollment ID: I20250526000043 |
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 |