MOUNTAIN SAGE HOLISTIC CLINIC, LLC; NPI #1376924621

Contact Information

MOUNTAIN SAGE HOLISTIC CLINIC, LLC

1428 WARM SPRINGS DR
DUBOIS, WY 82513-1428

Phone: 307-455-2807
Fax: 307-455-2809
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Primary Care	363LP2300X	50	Nurse Practitioner

Indicates primary specialty

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NPI Profile & details for MOUNTAIN SAGE HOLISTIC CLINIC, LLC

NPI Number 1376924621

LBN Legal business name MOUNTAIN SAGE HOLISTIC CLINIC, LLC

Authorized official MARTIN BAUM - (BUSINESS MANAGER)

Entity Organization

Organization subpart ¹ No

Enumeration date 06/12/2015

Last updated 06/12/2015 - About 11 years ago

Identifiers

WY	License #	33105.1295
WY	Medicaid	136115500

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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