Provider Demographics
NPI:1699723395
Name:WIND RIVER EAR, NOSE & THROAT, INC
Entity type:Organization
Organization Name:WIND RIVER EAR, NOSE & THROAT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-335-7555
Mailing Address - Street 1:8185 HIGHWAY 789
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-2942
Mailing Address - Country:US
Mailing Address - Phone:307-335-7555
Mailing Address - Fax:307-335-7999
Practice Address - Street 1:8185 HIGHWAY 789
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-2942
Practice Address - Country:US
Practice Address - Phone:307-335-7555
Practice Address - Fax:307-335-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty