| Placebo Ventures, LLC | |
|
5715 E 2nd St Casper WY 82609-4322 | |
| (307) 265-0005 | |
| Not Available |
| Full Name | Placebo Ventures, LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 5715 E 2nd St, Casper, Wyoming |
| Authorized Official Name and Position | Joseph Edward Mickelson (PRESIDENT) |
| Authorized Official Contact | 3072650947 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Placebo Ventures, LLC 6010 S Walnut St Casper WY 82601-6248 Ph: (307) 265-0947 | Placebo Ventures, LLC 5715 E 2nd St Casper WY 82609-4322 Ph: (307) 265-0005 |
| NPI Number | 1245559012 |
|---|---|
| Provider Enumeration Date | 05/19/2010 |
| Last Update Date | 08/11/2020 |
| Certification Date | 08/11/2020 |
| Medicare PECOS PAC ID | 8729102504 |
|---|---|
| Medicare Enrollment ID | O20100831000525 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245559012 | NPI | - | NPPES |
| 315272 | Other | WY | BLUE CROSS/BLUE SHIELD |
| 110845000 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Joseph Mickelson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467448043 PECOS PAC ID: 2668365008 Enrollment ID: I20050822000307 |
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