NPIMap

Organization Active NPI

Jackson Hole Medical Clinic, LLC

Doing business as Allergy & Asthma Clinic of Jackson Hole

  • Allergy Physician
  • Jackson, WY
National Provider Identifier
1699817668
Registry record updated Apr 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy PhysicianTaxonomy code 207KA0200X
License
5551A Issued in WY
Legal business name
JACKSON HOLE MEDICAL CLINIC, LLC
Doing business as
Allergy & Asthma Clinic of Jackson Hole
Practice address
1415 S. Highway 89
Jackson, WY 83001
Phone
(307) 739-8999
NPI assigned
Feb 13, 2007
Last updated
Apr 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2008

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

Authorized official

Name
Franklin Rivers Jr., MDNPI 1710984315
Title
Owner
Phone
(307) 739-8999

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
Allergy Physician 207KA0200X 5551A WY Primary

Addresses

Primary practice location

1415 S. Highway 89
Jackson, WY 83001

Mailing address

PO Box 8640
Jackson, WY 83002-8640
Phone (307) 739-8999

Other identifiers 1

IdentifierTypeStateIssuer
1699817668MedicaidWY

Other names 1

  • Allergy & Asthma Clinic of Jackson Hole Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208476800000",
    "number": "1699817668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8640",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830028640",
            "telephone_number": "307-739-8999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 S. HIGHWAY 89",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "83001",
            "telephone_number": "307-739-8999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HOLE MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2008-04-18",
        "status": "A",
        "authorized_official_last_name": "RIVERS",
        "authorized_official_first_name": "FRANKLIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "307-739-8999",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "WY",
            "license": "5551A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699817668",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allergy & Asthma Clinic of Jackson Hole",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; 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.