Organization
RED ROCK FAMILY PRACTICE, INC
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
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116973401
—
WY
Enumeration date
03/02/2006
Last updated
12/29/2017
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