MOUNTAIN TRAIL MEDICAL (NPI# 1760956924) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760956924 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN TRAIL MEDICAL |
| Practice Address |
542 16th St Rawlins WY 82301-5241 |
| Mailing Address |
1704 Mercil Ct Apt A Laramie WY 82070-5600 |
| Practice Telephone | 3073242759 |
| Mailing Telephone | 3073207075 |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2019-01-21 |
| Authorized Official Name | DR. MARVIN WAYNE COUCH II (PRESIDENT/OWNER) |
| Authorized Official Telephone | 3073207075 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
542 16TH ST |
| City | RAWLINS |
| State | WY |
| Zip Code | 82301-5241 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659531630 | Martin Peterson | Specialist | 542 16th St, Rawlins, WY 82301-5241 | 2008-06-12 |
| 1194369132 | Kelsey Carolan | Physical Therapist | 542 16th St, Rawlins, WY 82301-5241 | 2019-11-02 |
| 1891347621 | Megan Mccabe | Physical Therapist | 542 16th St, Rawlins, WY 82301-5241 | 2019-07-11 |
| 1366911257 | Jared Pulliam | Occupational Therapist | 542 16th St, Rawlins, WY 82301-5241 | 2018-11-20 |
| 1144702556 | Elizabeth Demoss | Occupational Therapist | 542 16th St, Rawlins, WY 82301-5241 | 2018-08-31 |
| 1023590437 | Nathan Buchanan | Physical Therapist | 542 16th St, Rawlins, WY 82301-5241 | 2018-08-31 |
| 1427575695 | Ann Marie Marta | Occupational Therapist | 542 16th St, Rawlins, WY 82301-5241 | 2017-08-28 |
| 1619352242 | Empres At Rawlins, LLC | Skilled Nursing Facility | 542 16th St, Rawlins, WY 82301-5241 | 2015-07-24 |
| 1821475310 | Regina Claire Spaay | Community Health Worker | 542 16th St, Rawlins, WY 82301-5241 | 2015-05-04 |
| 1902227929 | Donald Burmeister | Speech-Language Pathologist | 542 16th St, Rawlins, WY 82301-5241 | 2013-12-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619583606 | Kyliah Petrita Ferris | Speech-Language Pathologist | 1801 Edinburgh Street #2, Rawlins, WY 82301 | 2020-09-16 |
| 1427571454 | Levi Pearce Brinkerhoff | Dentist | 2900 S Higley Blvd, Rawlins, WY 82301 | 2017-07-21 |
| 1861928012 | Stephanie Murry | Speech-Language Pathologist | 1801 Edinburgh, Rawlins, WY 82301 | 2017-05-10 |
| 1992167811 | Gwen Louise Gale | Registered Nurse | 2 North Cherokee Rd, Rawlins, WY 82301 | 2016-03-22 |
| 1194109520 | Alison Brown | Case Management | 2014 E Cedar St Suite B, Rawlins, WY 82301 | 2015-07-15 |
| 1003238718 | Jessica Zamudio Bright | Marriage & Family Therapist | 1800 Edinburgh Street, Rawlins, WY 82301 | 2014-01-15 |
| 1093149965 | Michele Dolores Deherrera | Social Worker | 1800 Edinburgh, Rawlins, WY 82301 | 2013-08-28 |
| 1295019693 | Amber Jeanne Green | Case Manager/Care Coordinator | 1209 Lambda Dr, Rawlins, WY 82301 | 2011-10-04 |
| 1730477266 | Cowboy Urgent Care, Inc | Clinic/Center | 519 8th Street, Rawlins, WY 82301 | 2011-07-19 |
| 1588990949 | Skylar Jason Brenden | Chiropractor | 801 West Maple, Rawlins, WY 82301 | 2009-10-20 |
| Find all providers in zip 82301 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| 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. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306008008 | Joan Robia Johnson | Family Medicine | 1016 W Spruce St Unit A, Rawlins, WY 82301-5371 | 2008-06-25 |
| 1730228917 | John William Whitaker | Family Medicine | 1016 W Spruce St, Rawlins, WY 82301-5371 | 2007-02-05 |
| 1538252077 | Charles C Young | Family Medicine | 1812 Daley St, Rawlins, WY 82301-5912 | 2006-10-02 |
| 1023038510 | Rawlins Family Medical, PC | Family Medicine | 606 23rd St, Rawlins, WY 82301-5127 | 2006-07-20 |
| 1497756118 | David R Cesko | Family Medicine | 819 W Maple St, Rawlins, WY 82301-5462 | 2005-08-03 |
| 1013528298 | Valence Health Corp PC | Family Medicine | 1016 W Spruce St Unit A, Rawlins, WY 82301-5371 | 2020-08-12 |
| 1912455155 | Charles C Young Md LLC | Family Medicine | 1812 Daley St, Rawlins, WY 82301-5912 | 2016-09-16 |
| 1508152786 | Stephanie Chiu | Family Medicine | 2221 Elm St, Rawlins, WY 82301-5108 | 2011-06-25 |
| 1366621476 | Cesko Family Practice PC | Family Medicine | 819 W Maple St, Rawlins, WY 82301-5462 | 2007-10-25 |
| 1508900341 | Memorial Hospital of Carbon County | Family Medicine | 2012 W Elm Street, Rawlins, WY 82301 | 2007-02-16 |
| Find all providers in RAWLINS | ||||
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| 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.