BRENT BLUE MD


Address: 982 W Broadway, Jackson, WY 83001
Phone: 3077338002

BRENT BLUE MD (NPI# 1356556518) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1356556518
Entity Type Organization
Organization Name BRENT BLUE MD
Other Organization Name EMERGACARE
Practice Address 982 W Broadway
Jackson
WY 83001
Mailing Address Po Box 15240
Jackson
WY 83002-5240
Practice Telephone 3077338002
Practice Fax Number 3077330032
Mailing Telephone 3077338002
Mailing Fax Number 3077330032
Enumeration Date 2007-05-11
Last Update Date 2010-06-28
Authorized Official Name BRENT BLUE (OWNER)
Authorized Official Telephone 3077338002
Authorized Official Credential MD
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QU0200X Clinic/Center
Specialization: Urgent Care
3416A WY Ambulatory Health Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
WY USDOL CLINIC NUMBER 218545001 01
WY 109651600 05

Other Provider/Organization Names

Other Name Type Code
EMERGACARE Doing Business As Name - Organization

Office Location

Street Address 982 W BROADWAY
City JACKSON
State WY
Zip Code 83001

Providers in the same location

NPI Name Taxonomy Address Enumeration
1063467538 Brent Blue Emergency Medicine 982 W Broadway, Jackson, WY 83001-5240 2006-05-23

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1861006108 Anne Kathleen Milburn Physical Therapist 3620 S Park Drive, Jackson, WY 83001 2020-09-03
1568009637 Katherine Pringle Ford Case Manager/Care Coordinator 2065 E. Limber Pine Road, Jackson, WY 83001 2019-12-07
1043878408 Cossette Burnham Physical Therapist Four Pines Physical Therapy, 1090 S Hwy 89, Jackson, WY 83001 2019-05-31
1982169371 Cynthia Buck Huyffer Social Worker 755a Cache Creek Drive, Jackson, WY 83001 2019-02-10
1093281594 Lara Cilo Speech-Language Pathologist 1300 W. Valley Springs Road, Jackson, WY 83001 2018-10-23
1740776202 Teton Oral and Maxillofacial Surgery Dentist 1160 Alpine Ln Ste 1d, Jackson, WY 83001 2018-07-09
1437642055 Anna Yanchek Physical Therapist 1090 Us- 89, Jackson Hole, WY 83001 2018-06-08
1891200762 Tyler Ross Wright Chiropractor 1325 Us-89, Suite 108, Jackson, WY 83001 2017-12-13
1073027280 Root To Rise Counseling and Consulting, Pllc Social Worker 2033 Dandelion Court, Jackson, WY 83001 2017-11-27
1962923912 Piper Worthington Social Worker 1910 High School Rd, Jackson, WY 83001 2017-06-29
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Taxonomy Information

Taxonomy Code 261QU0200X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Urgent Care

Taxonomy Definition

Definition to come...

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1356882039 Thomas Alan Bowhay Clinic/Center 820 Highway 88, Jackson, CA 95642 2017-03-15
1255836763 W A Foote Memorial Hospital Inc Clinic/Center 1401 W North St, Jackson, MI 49202-3135 2018-03-27
1699149773 Hope Urgent Care Jackson Clinic/Center 200 Summit Ave, Jackson, MI 49201-2464 2015-11-30
1598040628 Jackson Urgent Care Clinic/Center 731 E Main St, Jackson, OH 45640-2100 2011-10-20
1083884126 Wa Foote Memorial Hospital, Inc Clinic/Center 205 N East Ave, Jackson, MI 49201-1753 2008-03-05
1891965943 Wa Foote Memorial Hospital, Inc Clinic/Center 205 N East Ave, Jackson, MI 49201-1753 2008-03-05
1457538324 Adena Health System Clinic/Center 1000 Veterans Dr, Jackson, OH 45640-9586 2008-01-23

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1124662879 Buffalo Urgent Care Inc Clinic/Center 496 Fort St, Buffalo, WY 82834-1806 2019-11-05
1851894810 Great Plains Telehealth Clinic/Center 3901 S College Park Ct, Gillette, WY 82718-9441 2018-03-15
1275070708 Sugar Land Walk-in Clinic Clinic/Center 1005 Sugarland Dr, Sheridan, WY 82801 2017-01-23
1609118686 Dennis Goldberg Clinic/Center 1254 Lane 8, Powell, WY 82435-9303 2013-03-18
1053493403 Medcor of Barrington, PC Clinic/Center 1 Old Faithful Hot Springs, Yellowstone Nat'l Park, WY 82190 2006-10-19
1467939918 South Lincoln Hospital District Clinic/Center 711 Onyx St, Kemmerer, WY 83101-3214 2018-07-26
1174983118 Grand Avenue Urgent Care, LLC Clinic/Center 3236 E Grand Ave Ste D, Laramie, WY 82070-5100 2016-03-03
1578824801 Cheyenne Regional Urgent Care, LLC Clinic/Center 433 E 19th St, Cheyenne, WY 82001-4643 2012-06-04
1437416443 Frontier Medical Providers Clinic/Center 433 E 19th St, Cheyenne, WY 82001-4643 2012-04-15
1457651663 Americas Express Urgent Care, LLC Clinic/Center 7124 Commons Dr, Suite C, Cheyenne, WY 82009-2620 2010-10-22
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Competitor

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City JACKSON
Zip Code 83001

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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