Provider Demographics
NPI:1588765069
Name:PATHWAY, INC.
Entity type:Organization
Organization Name:PATHWAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-721-0700
Mailing Address - Street 1:1575 N 4TH ST
Mailing Address - Street 2:SUITE #103
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2091
Mailing Address - Country:US
Mailing Address - Phone:307-721-0700
Mailing Address - Fax:307-721-1039
Practice Address - Street 1:1575 N 4TH ST
Practice Address - Street 2:SUITE #103
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2091
Practice Address - Country:US
Practice Address - Phone:307-721-0700
Practice Address - Fax:307-721-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY05617001OtherBLUE CROSS BLUE SHEILD
WY119619700Medicaid