| Organization Name: | WYOMING INTERVENTIONAL PAIN MANAGEMENT LLC |
| NPI Number: | 1083942080 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LOWELL AMIOTTE (PRESIDENT) |
| Mailing Address: | 1301 W 3rd St Gillette |
| State: | WY US |
| Postal Code: | 827163335 |
| Phone Number: | 3076827819 |
| Fax Number: | 3076858027 |
| NPI Enumeration Date: | 12/02/2009 |
| NPI Last Update Date: | 06/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP3300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Pain |
| Taxonomy Definition: | |