Provider Demographics
NPI:1154342921
Name:MEDIHORIZONS INC
Entity type:Organization
Organization Name:MEDIHORIZONS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOUGL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-635-5393
Mailing Address - Street 1:PO BOX 20170
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7004
Mailing Address - Country:US
Mailing Address - Phone:307-635-5393
Mailing Address - Fax:307-635-2199
Practice Address - Street 1:1950 BLUEGRASS CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7323
Practice Address - Country:US
Practice Address - Phone:307-635-5393
Practice Address - Fax:307-635-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYCN3773OtherRAILROAD MEDICARE
WY112579600Medicaid
WYCN3773OtherRAILROAD MEDICARE