| Organization Name: | FREMONT RADIOLOGY PC |
| NPI Number: | 1124207345 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VALERIE LAWRENCE (OFFICE MANAGER) |
| Mailing Address: | 2102 W Sunset Dr Riverton |
| State: | WY US |
| Postal Code: | 82501 |
| Phone Number: | 3078566530 |
| Fax Number: | |
| NPI Enumeration Date: | 10/25/2007 |
| NPI Last Update Date: | 10/25/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1200X |
| License Number: | FDTC-300 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Magnetic Resonance Imaging (MRI) |
| Taxonomy Definition: | |