Provider Demographics
NPI:1528052263
Name:FREMONT FAMILY PRACTICE, P.C.
Entity type:Organization
Organization Name:FREMONT FAMILY PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:STEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-856-7800
Mailing Address - Street 1:1130 MAJOR AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-2342
Mailing Address - Country:US
Mailing Address - Phone:307-856-7800
Mailing Address - Fax:307-857-7076
Practice Address - Street 1:1130 MAJOR AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2342
Practice Address - Country:US
Practice Address - Phone:307-856-7800
Practice Address - Fax:307-857-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW10471Medicare ID - Type UnspecifiedPROVIDER NUMBER