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Organization
BIG HORN PEDIATRICS
Active
Organization
BIG HORN PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN L EDWARDS (OFFICE MANAGER)
(307) 687-1300
Entity
Organization
Contact information
Practice address
1308 W 4TH ST, GILLETTE, WY 82716-3330
(307) 687-1300
(307) 682-1309
Mailing address
1308 W 4TH ST, GILLETTE, WY 82716-3330
(307) 687-1300
(307) 682-1309
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
Primary
—
NULL
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
830306207
TAX I.D.#
WY
Enumeration date
08/24/2006
Last updated
07/27/2020
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