NPI 1790824530

Shoshone Tribe

Organisation End-Stage Renal Disease (ESRD) Treatment Clinic/Center Fort Washakie, WY

Practice location

Address: 11 Shipton Lane, Fort Washakie, WY 82514
Phone: (307) 332-2998
Fax: (307) 332-4955
Mailing address: PO Box 998, Fort Washakie, WY 82514-0998

Authorised official

Name: Diane Garcia
Title: Ceo, Nurse Manager
Phone: (307) 332-2998

Registered specialties

End-Stage Renal Disease (ESRD) Treatment Clinic/Center Primary

Ambulatory Health Care Facilities Taxonomy 261QE0700X Licence 07-177 (WY)

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Registry record

NPI: 1790824530
Entity type: Organization
NPI issued: 6 Feb 2007
Record last updated: 24 Apr 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.