Organization
SWEETWATER RADIOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN A HOLTAN MD (PRESIDENT)
(623) 399-3266
Entity
Organization
Contact information
Practice address
1400 UINTA DR, GREEN RIVER, WY 82935-5060
(307) 872-4541
Mailing address
PO BOX 2146, ROCK SPRINGS, WY 82902-2146
(405) 947-5557
(405) 948-6507
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00983001
BCBS OF WY
WY
05
—
106271900
—
WY
Enumeration date
06/14/2006
Last updated
08/05/2011
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