Organization
SHOSHONE TRIBE
Active
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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