NPIMap

Organization Active NPI

Family Care Clinic, LLC

  • Primary Care Clinic/Center
  • Laramie, WY
National Provider Identifier
1285777607
Registry record updated Apr 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
FAMILY CARE CLINIC, LLC
Practice address
204 McCollum St Ste 104
Laramie, WY 82070-5151
Phone
(307) 745-0085
Fax
(307) 745-0084
NPI assigned
Feb 15, 2007
Last updated
Apr 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Teri Jean Ourada, DNP, APRN-CNPI 1700490489
Title
Owner
Phone
(307) 745-0085

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

204 McCollum St Ste 104
Laramie, WY 82070-5151

Mailing address

204 McCollum St Ste 104
Laramie, WY 82070-5151
Phone (307) 745-0085

Other identifiers 2

IdentifierTypeStateIssuer
118524100MedicaidWY
53D1012895OtherWYCLIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040420000459 WY Part B Supplier - Clinic/Group Practice 9739174525 Receives reassigned benefits from 3 practitioners
Practice locations: Laramie, WY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
53D1012895Family Care Clinic LLC204 McCollum Street, Suite 104, Laramie, WY 82070Provider-performed microscopyMay 22, 2027

National Provider Directory

National Provider Directory

Locations

204 McCullum Dr
Ste 104
Laramie, WY 82070
Phone (307) 745-0085

504 E Lyon St
Laramie, WY 82072
Phone (307) 223-2172

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682812800000",
    "number": "1285777607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 MCCOLLUM ST STE 104",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820705151",
            "telephone_number": "307-745-0085",
            "fax_number": "307-745-0084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 MCCOLLUM ST STE 104",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820705151",
            "telephone_number": "307-745-0085",
            "fax_number": "307-745-0084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2023-04-30",
        "certification_date": "2023-04-30",
        "status": "A",
        "authorized_official_last_name": "OURADA",
        "authorized_official_first_name": "TERI",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "307-745-0085",
        "authorized_official_credential": "DNP, APRN-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118524100",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "53D1012895",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laramie, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.