Organization
PPM WYOMING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER TUELLER (CORPORATE SECRETARY)
(208) 401-1400
Entity
Organization
Contact information
Practice address
770 S WASHINGTON ST STE B, AFTON, WY 83110-5135
(888) 253-6598
Mailing address
1916 N 700 W STE 110, LAYTON, UT 84041-5754
(385) 427-1570
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
07/09/2024
Last updated
07/09/2024
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