BRENT BLUE MD NPI 1356556518

NPI Information

NPI: 1356556518
Provider Name: BRENT BLUE MD

Doing Business As: EMERGACARE

Classification: Clinic/Center - 261QU0200X
Entity Type: Organization

Specialization: Urgent Care

Address:
982 W BROADWAY
JACKSON, WY
ZIP 83001
Phone: (307) 733-8002
Get Directions

BRENT BLUE MD is an urgent care clinic center in Jackson, WY. BRENT BLUE MD NPI is 1356556518. The provider is registered as an organization entity type.
The provider Is Doing Business As Emergacare.

The provider's business location address is:

982 W BROADWAY
JACKSON, WY
ZIP 83001
Phone: (307) 733-8002
Fax: (307) 733-0032

The provider's authorized official is Brent Blue .
The authorized official title is Owner and has the following contact phone number (307) 733-8002.

The CLIA number assigned to this NPI record is 53D0666667 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/11/2007 and was last updated on 6/28/2010.

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
1	261QU0200X	Clinic/Center	Urgent Care	3416A	WYOMING	Yes

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
1	4371429	MEDICARE ID-TYPE UNSPECIFIED	WYOMING	RAILROAD MCARE GR NUMBER
2	109651600	MEDICAID	WYOMING
3	218545001	OTHER	WYOMING	USDOL CLINIC NUMBER
4	W305961	MEDICARE PIN

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: 4/28/2024

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