NPIMap

Organization Active NPI

Early Intervention Program

  • Early Intervention Provider Agency
  • Fort Washakie, WY
National Provider Identifier
1831581719
Registry record updated Apr 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
129040100 Issued in WY
Legal business name
EARLY INTERVENTION PROGRAM
Practice address
9 Shipton Lane
Fort Washakie, WY 82514-0610
Phone
(307) 332-3516
Fax
(307) 332-9116
NPI assigned
Mar 2, 2015
Last updated
Apr 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2017

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

Authorized official

Name
Laurene Hines
Title
Assistant Director
Phone
(307) 332-3516

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X 129040100 WY Primary

Addresses

Primary practice location

9 Shipton Lane
Fort Washakie, WY 82514-0610

Mailing address

PO Box 610
Fort Washakie, WY 82514-0610
Phone (307) 332-3516

Other identifiers 1

IdentifierTypeStateIssuer
129040100MedicaidWY

National Provider Directory

National Provider Directory
Tax ID family
Shoshone Tribe Early Intervention Program8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1425254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493337600000",
    "number": "1831581719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 610",
            "city": "FORT WASHAKIE",
            "state": "WY",
            "postal_code": "825140610",
            "telephone_number": "307-332-3516",
            "fax_number": "307-332-9116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 SHIPTON LANE",
            "city": "FORT WASHAKIE",
            "state": "WY",
            "postal_code": "825140610",
            "telephone_number": "307-332-3516",
            "fax_number": "307-332-9116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EARLY INTERVENTION PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-02",
        "last_updated": "2017-04-28",
        "status": "A",
        "authorized_official_last_name": "HINES",
        "authorized_official_first_name": "LAURENE",
        "authorized_official_title_or_position": "ASSISTANT DIRECTOR",
        "authorized_official_telephone_number": "307-332-3516"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "WY",
            "license": "129040100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129040100",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Washakie, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2017; 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.