# WYOMING HEALTH MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BANNER MEDICAL GROUP COLORADO
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1346951944
- **Legal business name:** BANNER MEDICAL GROUP COLORADO
- **Authorized official:** MARGO KARSTEN (DIVISION PRESIDENT)
- **Authorized official phone:** (602) 747-4000

## Contact information

- **Practice address:** 419 S WASHINGTON ST STE 102, CASPER, WY 82601-2951
- **Practice address phone:** (307) 237-5047
- **Mailing address:** 2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133NN1002X | Nutrition Education Nutritionist | — | NULL | Yes |
| 133NN1002X | Nutrition Education Nutritionist | — | — | Yes |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 12/06/2022
- **Last updated:** 12/06/2022