# WESTERN TRAILS FAMILY MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205223740
- **Authorized official:** MR. JOHN WESLY BOWLIN PT, DPT (PRESIDENT)
- **Authorized official phone:** (308) 623-1313

## Contact information

- **Practice address:** 1463 17TH AVE, MITCHELL, NE 69357-1429
- **Practice address phone:** (308) 623-1313
- **Practice address fax:** (308) 623-1313
- **Mailing address:** 1463 17TH AVE, MITCHELL, NE 69357-1429
- **Mailing address phone:** (308) 623-1313
- **Mailing address fax:** (308) 623-1315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/22/2015
- **Last updated:** 04/22/2015