Provider Demographics
NPI:1144660044
Name:WYOMING FAMILY SONOGRAPHY, LLC
Entity type:Organization
Organization Name:WYOMING FAMILY SONOGRAPHY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:BENNIGAN
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-438-9844
Mailing Address - Street 1:PO BOX 1827
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-1827
Mailing Address - Country:US
Mailing Address - Phone:307-438-9844
Mailing Address - Fax:
Practice Address - Street 1:733 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-2733
Practice Address - Country:US
Practice Address - Phone:307-438-9844
Practice Address - Fax:307-335-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085U0001X
WY2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW25911Medicare PIN
WYW25911Medicare PIN
WY408432OtherARRT