Cody Clinic
Organization Active NPI Internal Medicine Physician · Cody, WY
NPI 1104422237 · NPPES record last updated Feb 17, 2021
Key facts
- NPI
- 1104422237
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- CODY CLINIC
- Practice address
- 2107 Sheridan Avenue
Cody, WY 82414 - Phone
- (307) 586-5303
- NPI assigned
- Dec 4, 2020
- Organization subpart
- No
Authorized official
- Name
- Judd L Larowe, MD
- Title
- President
- Phone
- (307) 586-5303
Practitioners 1
-
Judd Larowe, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 53D2210975 | Cody Clinic | Certificate of waiver | Jan 24, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210206000039 | WY | Part B Supplier - Clinic/Group Practice | 2163836917 |
Receives reassigned benefits from 1 practitioner Practice locations: Cody, WY |
National Provider Directory
Interoperability endpoints
- https://api.platform.athenahealth.com/22731/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
2107 Sheridan Avenue
Cody, WY 82414
Mailing address
PO Box 727
Cody, WY 82414-0727
Phone (307) 586-5303
Other providers in Cody, WY
- Sheldon Joseph Clark
- Pamela P Clegg
- Cloud Peak Counseling
- Cloud Peak Counseling Center
- Cody Chiropractic Center PC
- Cody Dental Excellence
- Cody Imaging Center LLC
- Cody Regional Health EMS
- Cody Senior Living, LLC
- Cody Surgical Associates LLC
All providers in Cody, WY · Internal Medicine Physician in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 17, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.