Organization
PAIN TREATMENT CENTER OF WYOMING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HARLAN R RIBNIK M.D. (PHYSICIAN OWNER)
(307) 633-8100
Entity
Organization
Contact information
Practice address
903 S GREELEY HWY, SUITE A, CHEYENNE, WY 82007-3057
(307) 633-8100
(307) 633-8108
Mailing address
PO BOX 20270, CHEYENNE, WY 82003-7006
(307) 633-8100
(307) 633-8108
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
4305A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
311983
BLUE CROSS BLUE SHIELD
WY
Enumeration date
06/30/2005
Last updated
08/22/2020
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