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Organization
EVANSTON CLINIC CORP
Active
Organization
EVANSTON CLINIC CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA J FEY (DIRECTOR REVENUE CYCLE)
(615) 221-3641
Entity
Organization
Contact information
Practice address
196 ARROWHEAD DR STE 8, EVANSTON, WY 82930-8752
(307) 783-8365
(307) 783-8284
Mailing address
PO BOX 5009, BRENTWOOD, TN 37024-5009
(615) 221-1400
(615) 465-2984
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
WY
207R00000X
Internal Medicine Physician
—
WY
207V00000X
Obstetrics & Gynecology Physician
—
WY
208600000X
Surgery Physician
—
WY
208800000X
Urology Physician
—
WY
208D00000X
General Practice Physician
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06159001
BCBS
WY
05
—
1013916519
—
WY
Enumeration date
07/18/2005
Last updated
03/04/2019
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