# RED ROCK FAMILY PRACTICE, INC

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

## Provider details

- **NPI number:** 1316914922
- **Authorized official:** MR. WADE TRAVIS BOMENGEN M.D. (OWNER)
- **Authorized official phone:** (307) 864-5534

## Contact information

- **Practice address:** 120 N C AVE, THERMOPOLIS, WY 82443-2410
- **Practice address phone:** (307) 864-5534
- **Practice address fax:** (307) 864-9470
- **Mailing address:** 120 N C AVE, THERMOPOLIS, WY 82443-2410
- **Mailing address phone:** (307) 864-5534
- **Mailing address fax:** (307) 864-9470

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/02/2006
- **Last updated:** 12/29/2017