Provider Demographics
NPI:1104976372
Name:US HEALTH DEPT OF HEALTH & HUMAN SERVICES
Entity type:Organization
Organization Name:US HEALTH DEPT OF HEALTH & HUMAN SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACTING CEO/ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-332-7300
Mailing Address - Street 1:PO BOX 1310
Mailing Address - Street 2:14 GREAT PLAINS RD ARAPAHOE WY 82501
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-0158
Mailing Address - Country:US
Mailing Address - Phone:307-856-9281
Mailing Address - Fax:307-856-1630
Practice Address - Street 1:14 GREAT PLAINS ROAD
Practice Address - Street 2:
Practice Address - City:ARAPAHOE
Practice Address - State:WY
Practice Address - Zip Code:82501
Practice Address - Country:US
Practice Address - Phone:307-856-9281
Practice Address - Fax:307-856-1630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
Provider Identifiers
StateIdentifier IDID TypeIssuer
HSZ035Medicare PIN