Organization
WIND RIVER RADIOLOGY P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY E MAGNUSON (OFFICE MANAGER)
(307) 332-2357
Entity
Organization
Contact information
Practice address
295 GARFIELD ST, LANDER, WY 82520-3121
(307) 335-6451
(307) 335-6467
Mailing address
295 GARFIELD ST, LANDER, WY 82520-3121
(307) 332-2357
(307) 332-4276
Taxonomy
Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104516
—
MT
05
—
104550
—
MT
Enumeration date
04/12/2007
Last updated
01/18/2008
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