Organization
STAR VALLEY MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REBECCA ERICKSON BS (OWNER)
(307) 885-0005
Entity
Organization
Contact information
Practice address
32 EAST 4TH AVE, AFTON, WY 83110-1676
(307) 885-0005
(307) 885-0045
Mailing address
PO BOX 1676, AFTON, WY 83110-1676
(307) 885-0005
(307) 885-0045
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B08077831
—
WY
Enumeration date
03/07/2013
Last updated
04/12/2021
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