Organization
RED ROCK FAMILY PRACTICE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WADE TRAVIS BOMENGEN M.D. (OWNER)
(307) 864-5534
Entity
Organization
Contact information
Practice address
120 N C AVE, THERMOPOLIS, WY 82443-2410
(307) 864-5534
(307) 864-9470
Mailing address
120 N C AVE, THERMOPOLIS, WY 82443-2410
(307) 864-5534
(307) 864-9470
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116973400
—
WY
05
—
116973402
—
WY
01
—
53D0996144
CLIA
WY
Enumeration date
03/07/2006
Last updated
06/07/2012
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