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Organization
WYOMING HEALTH MEDICAL GROUP, LLC
Active
Organization
WYOMING HEALTH MEDICAL GROUP, LLC
Active
Parent organization
BANNER MEDICAL GROUP COLORADO
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNER MEDICAL GROUP COLORADO
Authorized official
MARGO KARSTEN (DIVISION PRESIDENT)
(602) 747-4000
Entity
Organization
Contact information
Practice address
419 S WASHINGTON ST STE 102, CASPER, WY 82601-2951
(307) 237-5047
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
NULL
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
Other
Enumeration date
12/06/2022
Last updated
12/06/2022
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