Organization
FAMILY FIRST HEALTH PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA J MASON (PRESIDENT)
(307) 201-1696
Entity
Organization
Contact information
Practice address
555 E BROADWAY AVE, STE 218, JACKSON, WY 83001-8640
(307) 201-1696
Mailing address
PO BOX 12568, JACKSON, WY 83002-2568
(307) 201-1696
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
263300970
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W24204
MEDICARE PTAN
WY
Enumeration date
07/06/2011
Last updated
06/21/2016
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