# BIG HORN PEDIATRICS

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

## Provider details

- **NPI number:** 1477660447
- **Authorized official:** ANN L EDWARDS (OFFICE MANAGER)
- **Authorized official phone:** (307) 687-1300

## Contact information

- **Practice address:** 1308 W 4TH ST, GILLETTE, WY 82716-3330
- **Practice address phone:** (307) 687-1300
- **Practice address fax:** (307) 682-1309
- **Mailing address:** 1308 W 4TH ST, GILLETTE, WY 82716-3330
- **Mailing address phone:** (307) 687-1300
- **Mailing address fax:** (307) 682-1309

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | Yes |
| 208000000X | Pediatrics Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/24/2006
- **Last updated:** 07/27/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 830306207 | TAX I.D.\# | WY |