NPI 1013916519 · live from the CMS NPI Registry
Evanston Clinic Corp
Family Medicine in Evanston, WY. National Provider Identifier 1013916519, active.
NPI record
| NPI | 1013916519 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine 207Q00000X |
| Practice location | 196 Arrowhead Dr Ste 8, Evanston, WY 82930 |
| Practice phone | 307-783-8365 |
| Mailing address | Po Box 5009, Brentwood, TN 37024 |
| Enumerated | July 18, 2005 |
| Last updated | March 4, 2019 |
| Authorized official | Laura Fey, Director Revenue Cycle |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Family | 363LF0000X | — |
| Internal Medicine | 207R00000X | — (WY) |
| Obstetrics & Gynecology | 207V00000X | — (WY) |
| Surgery | 208600000X | — (WY) |
| Urology | 208800000X | — (WY) |
| General Practice | 208D00000X | — |
| Physician Assistant | 363A00000X | — |
| Physician Assistant, Medical | 363AM0700X | — |
| Family Medicine primary | 207Q00000X | — (WY) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.