# FREMONT COUNTY PEDIATRIC CLINIC

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

## Provider details

- **NPI number:** 1578664066
- **Authorized official:** RICHARD E. BARNES M.D. (OWNER)
- **Authorized official phone:** (307) 332-2185

## Contact information

- **Practice address:** 115 WYOMING ST, LANDER, WY 82520-3919
- **Practice address phone:** (307) 332-2185
- **Practice address fax:** (307) 332-7799
- **Mailing address:** 115 WYOMING ST, LANDER, WY 82520-3919
- **Mailing address phone:** (307) 332-2185
- **Mailing address fax:** (307) 332-7799

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 5774A | WY | Yes |

## Other

- **Enumeration date:** 09/26/2006
- **Last updated:** 04/25/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 111666500 | — | WY |
| 01 | — | W308732 | MEDICARE PTAN | WY |