Organization
EVANSTON CLINIC CORP
Active
Parent organization
EVANSTON CLINIC CORP
Other names
Bridger Valley Family Practice
Organization subpart
Yes
Provider details
NPI number
Legal business name
EVANSTON CLINIC CORP
Authorized official
DEBBIE T BREWER MBA (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7626
Entity
Organization
Contact information
Practice address
107 N MAIN ST, LYMAN, WY 82937
(307) 787-3313
Mailing address
7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829
(615) 465-7626
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
WY
Other
Enumeration date
10/15/2007
Last updated
10/15/2007
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