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Organization
RED ROCK FAMILY PRACTICE, PC
Active
Organization
RED ROCK FAMILY PRACTICE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WADE TRAVIS BOMENGEN M.D. (OWNER)
(307) 864-5534
Entity
Organization
Contact information
Practice address
120 N C AVE, THERMOPOLIS, WY 82443-2410
(307) 864-5534
(307) 864-9470
Mailing address
120 N C AVE, THERMOPOLIS, WY 82443-2410
(307) 864-5534
(307) 864-9470
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116973400
—
WY
05
—
116973402
—
WY
01
—
53D0996144
CLIA
WY
Enumeration date
03/07/2006
Last updated
06/07/2012
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