Organization
THOMAS H NIETHAMMER, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS H NIETHAMMER II M.D. (OWNER)
(307) 673-8383
Entity
Organization
Contact information
Practice address
1333 W 5TH ST, STE 206, SHERIDAN, WY 82801
(307) 673-8383
Mailing address
1333 W 5TH ST, STE 206, SHERIDAN, WY 82801
(307) 673-8383
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
3508A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02545001
BLUE CROSS
WY
05
—
122049700
—
WY
Enumeration date
06/28/2006
Last updated
11/12/2008
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