Evanston Clinic Corp is a health care provider in Brentwood, TN. In this page you will find its mailing address, practice location, phone number, specialty etc.
|Practice Location||107 N Main St, Lyman, WY 82937, US|
|Practice Location Phone||307-787-3313|
|Practice Location Fax|
|Legal Business Name||EVANSTON CLINIC CORP|
|Other Organization Name||BRIDGER VALLEY FAMILY PRACTICE|
|Other Organization Name Type||Doing Business As Name|
|Enumeration Date ?||Oct 15, 2007|
|Last Update Date ?||Oct 15, 2007|
NPI: National Provider Identifier issued to health care providers by Centers for Medicare and Medicaid Services (CMS).
|Specialty||Provider Type||Specialization||License||License State|
|Family Medicine||Allopathic & Osteopathic Physicians||Wyoming|
|Provider Id||Issuer State||Issuer Type||Issuer|
An authorized official is an appointed official with the legal authority to make changes and/or updates to the Evanston Clinic Corp's status and to commit the provider to fully abide by the laws and regulations relating to the National Provider Identifier (NPI).
|Authorized Official||Debbie T Brewer (MBA)|
|Authorized Official Title/Position||DIRECTOR OF PROVIDER ENROLLMENT|
|Authorized Official Phone Number||615-465-7626|