Organization
US HEALTH DEPT OF HEALTH & HUMAN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE ANTONE (ACTING CEO/ADMINISTRATIVE OFFICER)
(307) 332-7300
Entity
Organization
Contact information
Practice address
BLACK COAL DRIVE, #29, FORT WASHAKIE, WY 82514-0128
(307) 332-7300
(307) 332-7464
Mailing address
P.O. BOX 128, 29 BLACK COAL DRIVE, FORT WASHAKIE, WY 82514-0128
(307) 332-7300
(307) 332-7464
Taxonomy
Speciality
Code
Description
License number
State
261QP0904X
Federal Public Health Clinic/Center
Primary
—
—
Other
Enumeration date
12/29/2006
Last updated
05/24/2011
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