Organization · NPI-2

Evanston Clinic Corp

Family Medicine · Evanston, WY

NPI number1013916519

StatusActive

Last updated in NPPESMar 4, 2019

Details

NPI: 1013916519
Entity type: Organization (NPI-2)
Legal business name: Evanston Clinic Corp
Organization subpart: No
Enumeration date: Jul 18, 2005
Last updated: Mar 4, 2019

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207Q00000X	Family Medicine	–	WY	Yes
363LF0000X	Nurse Practitioner, Family	–	–
207R00000X	Internal Medicine	–	WY
207V00000X	Obstetrics & Gynecology	–	WY
208600000X	Surgery	–	WY
208800000X	Urology	–	WY
208D00000X	General Practice	–	–
363A00000X	Physician Assistant	–	–
363AM0700X	Physician Assistant, Medical	–	–

Practice location

196 Arrowhead Dr Ste 8
Evanston, WY 82930-8752

Phone 307-783-8365 · Fax 307-783-8284

Mailing address

Po Box 5009
Brentwood, TN 37024-5009

Phone 615-221-1400 · Fax 615-465-2984

Authorized official

Laura J Fey
Director Revenue Cycle
6152213641

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