Organization
PLACEBO VENTURES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH EDWARD MICKELSON M.D. (PRESIDENT)
(307) 265-0947
Entity
Organization
Contact information
Practice address
5715 E 2ND ST, CASPER, WY 82609-4322
(307) 265-0005
Mailing address
6010 S WALNUT ST, CASPER, WY 82601-6248
(307) 265-0947
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110845000
—
WY
01
—
315272
BLUE CROSS/BLUE SHIELD
WY
Enumeration date
05/19/2010
Last updated
08/11/2020
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