Clean Clinic Wyoming

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

Legal business name

CLEAN CLINIC WYOMING

Practice address

1918 Thomes Ave
Cheyenne, WY 82001-3527

Phone

(928) 242-9929

NPI assigned

Jun 1, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Lorence A Harmer

Title

Ceo

Phone

(801) 946-4045

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1654041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708128000000",
    "number": "1548909153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 E 11400 S # 275",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840706705",
            "telephone_number": "801-946-4045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 THOMES AVE",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013527",
            "telephone_number": "928-242-9929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAN CLINIC WYOMING",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-01",
        "last_updated": "2024-02-17",
        "certification_date": "2024-02-17",
        "status": "A",
        "authorized_official_last_name": "HARMER",
        "authorized_official_first_name": "LORENCE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "801-946-4045",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Liam Gerhardt Clark, MD
• Lindsey Ann Clark, FNP-C
• Michael V. Clark, DDS
• Samantha N Clark
• Jason Halsey Clarke, M.D.
• Meaghan Climis
• Clinical Decision Medical Services, LLC
• Renee Clontz, RRT
• Jennifer Elaine Cloward
• Tristin Cloward

• Addiction Medicine (Family Medicine) Physician in Cheyenne, WY
• Providers in Cheyenne, WY by specialty
• Addiction Medicine (Family Medicine) Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.