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Organization

UNIVERSITY OF WYOMING

Active
Parent organization
UNIVERSITY OF WYOMING
Other names
Pine Bluffs Clinic
Organization subpart
Yes

Provider details

NPI number
Legal business name
UNIVERSITY OF WYOMING
Authorized official
RONALD MALM MD (PROGRAM DIRECTOR)
(307) 632-2434
Entity
Organization

Contact information

Practice address
117 E 4TH ST, PINE BLUFFS, WY 82082
(307) 245-3666
Mailing address
820 E 17TH ST, CHEYENNE, WY 82001-4714
(307) 245-3666

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
261QF0400X
Federally Qualified Health Center (FQHC)
Primary

Other

Enumeration date
10/02/2014
Last updated
04/13/2016
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