| Organization Name: | WIND RIVER RADIOLOGY P C |
| NPI Number: | 1295959963 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY E MAGNUSON (OFFICE MANAGER) |
| Mailing Address: | 295 Garfield St Lander |
| State: | WY US |
| Postal Code: | 825203121 |
| Phone Number: | 3073356451 |
| Fax Number: | 3073356467 |
| NPI Enumeration Date: | 04/12/2007 |
| NPI Last Update Date: | 01/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471C3402X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Radiography |
| Taxonomy Definition: | |