Organization
RIVERTON PHYSICIAN PRACTICES LLC
Active
Other names
Wind River Oncology
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM M. GRACEY (COO)
(615) 372-8500
Entity
Organization
Contact information
Practice address
1035 ROSE LN, SUITE D, RIVERTON, WY 82501-2286
(307) 856-4688
Mailing address
PO BOX 758, POST FALLS, ID 83877-0758
(208) 773-6400
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
—
—
207RX0202X
Medical Oncology Physician
Primary
—
—
Other
Enumeration date
10/02/2008
Last updated
10/02/2008
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