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Organization
ABC PEDIATRICS LLC
Active
Organization
ABC PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RADONA KAY BORGIALLI (OFFICE MANAGER)
(307) 686-4900
Entity
Organization
Contact information
Practice address
1300 W 4TH ST, GILLETTE, WY 82716-3339
(307) 686-4900
(307) 682-3466
Mailing address
1300 W 4TH ST, GILLETTE, WY 82716-3339
(307) 686-4900
(307) 682-3466
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
5966A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121687200
—
WY
Enumeration date
06/30/2008
Last updated
06/30/2008
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