Organization
SHOSHONE TRIBE
Active
Other names
Wind River Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE GARCIA RN, BSN, CNN (CEO, NURSE MANAGER)
(307) 332-2998
Entity
Organization
Contact information
Practice address
11 SHIPTON LANE, FORT WASHAKIE, WY 82514
(307) 332-2998
(307) 332-4955
Mailing address
PO BOX 998, FORT WASHAKIE, WY 82514-0998
(307) 332-2998
(307) 332-4955
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
07-177
WY
Other
Enumeration date
02/06/2007
Last updated
04/24/2008
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