307 LONGEVITY PC NPI 1316783673

NPI Information

  • NPI: 1316783673
  • Provider Name: 307 LONGEVITY PC
  • Classification: Clinic/Center - 261Q00000X
  • Entity Type: Organization
  • CLIA Number: 53D2313176
  • Address: 1120 BECK AVE
    CODY, WY
    ZIP 82414
  • Phone: (307) 527-0355

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NPI Details

307 LONGEVITY PC is a clinic center in Cody, WY. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). 307 LONGEVITY PC NPI is 1316783673. The provider is registered as an organization entity type.

The provider's business location address is:

1120 BECK AVE
CODY, WY
ZIP 82414-624
Phone: (307) 527-0355
Fax: (307) 527-0360

The provider's authorized official is Christopher Thoma .
The authorized official title is Owner and has the following contact phone number (307) 899-0009.

The CLIA number assigned to this NPI record is 53D2313176 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/6/2024 and was last updated on 7/6/2024.

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
1261Q00000XClinic/CenterYes

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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