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JACKSON HOLE MEDICAL CLINIC, LLC

Allergy

Jackson, Wyoming

Provider NPI: 1699817668

Organization Information:
Organization Name:  JACKSON HOLE MEDICAL CLINIC, LLC


Practice Location:
1415 S. HIGHWAY 89  JACKSON, WY 83001 US
Tel: 307-739-8999  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207KA0200XPhysicians
Allergy & Immunology
Allergy
WY5551A

Other Provider Identifiers:

IssuerNumberStateType
1699817668WY05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




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