National Provider Identifier Database

COWBOY MEDICAL GROUP PC
Rural Health


Contact Information

COWBOY MEDICAL GROUP PC
1125 CHARLES AVE
WORLAND, WY82401-4021
Phone: 307-347-2449
Fax:
Website:
Specialty Taxonomy Code
* Rural Health 261QR1300X
Family Medicine 207Q00000X

* Indicates primary specialty

NPI Profile & details for COWBOY MEDICAL GROUP PC

NPI Number 1154836617
Legal business name
LBN
COWBOY MEDICAL GROUP PC
Authorized official WADE BOMENGEN - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 12/06/2017
Last updated 01/19/2018 - About 8 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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