| Medicine Bow Rural Health Care District | |
|
514 Idaho Dr Medicine Bow WY 82329-0037 | |
| (307) 379-2222 | |
| (307) 379-2223 |
| Full Name | Medicine Bow Rural Health Care District |
|---|---|
| Speciality | Clinic/Center |
| Location | 514 Idaho Dr, Medicine Bow, Wyoming |
| Authorized Official Name and Position | Adam Barron (MA/CPT/EMT) |
| Authorized Official Contact | 3073792222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medicine Bow Rural Health Care District Po Box 37 514 Idaho Dr Medicine Bow WY 82329-0037 Ph: (307) 379-2222 | Medicine Bow Rural Health Care District 514 Idaho Dr Medicine Bow WY 82329-0037 Ph: (307) 379-2222 |
| NPI Number | 1487756102 |
|---|---|
| Provider Enumeration Date | 09/02/2006 |
| Last Update Date | 03/03/2022 |
| Medicare PECOS PAC ID | 5799795985 |
|---|---|
| Medicare Enrollment ID | O20060503000104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487756102 | NPI | - | NPPES |
| 106597100 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | William C Lake |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497390017 PECOS PAC ID: 6204261977 Enrollment ID: I20200128000149 |
| Provider Name | Samantha Santy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023897626 PECOS PAC ID: 4587013180 Enrollment ID: I20250305001673 |