Provider Demographics
NPI:1104422237
Name:CODY CLINIC
Entity type:Organization
Organization Name:CODY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDD
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAROWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-586-5303
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-0727
Mailing Address - Country:US
Mailing Address - Phone:307-586-5303
Mailing Address - Fax:
Practice Address - Street 1:2107 SHERIDAN AVENUE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414
Practice Address - Country:US
Practice Address - Phone:307-586-5303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty