# GOOSE CREEK PEDIATRICS PC

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

## Provider details

- **NPI number:** 1407892300
- **Authorized official:** MARY I BOWERS MD (OWNER)
- **Authorized official phone:** (307) 672-7700

## Contact information

- **Practice address:** 1701 W 5TH ST, STE A, SHERIDAN, WY 82801-2748
- **Practice address phone:** (307) 672-7700
- **Mailing address:** 1701 W 5TH ST, STE A, SHERIDAN, WY 82801-2748
- **Mailing address phone:** (307) 672-7700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NULL | Yes |
| 208000000X | Pediatrics Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/21/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 8820875 | MONTANA MEDICAID | WY |