Bomengen, Wade Travis
Bomengen, Wade Travis is an individual health care provider with primary practice located at 120 N C Ave , Thermopolis WY 82443-2410. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Bomengen, Wade Travis can be contacted via phone (307) 864-5534.Contact Information
Primary practice address
120 N C Ave
Thermopolis WY 82443-2410
Phone: (307) 864-5534
Fax: (307) 864-9470
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 5946AWY | Wyoming |
Profile Details
| NPI number | 1710959168 |
|---|---|
| LBN Legal business name | Bomengen, Wade Travis |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 1st, 2006 |
| Last updated | Mar 7th, 2023 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710959168 | NPPES |
| Wyoming | Other | 5946AWY | WY MEDICAL LICENSE # |
| Wyoming | MEDICAID | 113009900 | WY MEDICAL LICENSE # |
| Wyoming | Other | 613WB97 | WY MEDICAL LICENSE # |
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