RED ROCK FAMILY PRACTICE PC NPI 1194792457

NPI Information

  • NPI: 1194792457
  • Provider Name: RED ROCK FAMILY PRACTICE, PC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Address: 120 N C AVE
    THERMOPOLIS, WY
    ZIP 82443
  • Phone: (307) 864-5534

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NPI Details

RED ROCK FAMILY PRACTICE, PC is a family medicine in Thermopolis, WY. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. RED ROCK FAMILY PRACTICE, PC NPI is 1194792457. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

120 N C AVE
THERMOPOLIS, WY
ZIP 82443-410
Phone: (307) 864-5534
Fax: (307) 864-9470

The provider's authorized official is Wade Travis Bomengen .
The authorized official title is Owner and has the following contact phone number (307) 864-5534.

The enumeration date for this NPI number is 3/7/2006 and was last updated on 6/7/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1308766MEDICARE ID-TYPE UNSPECIFIEDWYOMINGMEDICARE PART B
2116973400MEDICAIDWYOMING
3116973402MEDICAIDWYOMING
453D0996144OTHERWYOMINGCLIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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