NPI 1548909153 · live from the CMS NPI Registry
Clean Clinic Wyoming
Family Medicine, Addiction Medicine in Cheyenne, WY. National Provider Identifier 1548909153, active.
NPI record
| NPI | 1548909153 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine, Addiction Medicine 207QA0401X |
| Practice location | 1918 Thomes Ave, Cheyenne, WY 82001 |
| Practice phone | 928-242-9929 |
| Mailing address | 63 E 11400 S # 275, Sandy, UT 84070 |
| Enumerated | June 1, 2022 |
| Last updated | February 17, 2024 |
| Authorized official | Lorence Harmer, Ceo |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine, Addiction Medicine primary | 207QA0401X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.