Provider Demographics
NPI:1881901601
Name:CAMEL COUNTRY CLINIC, LLC
Entity type:Organization
Organization Name:CAMEL COUNTRY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCKINSEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:307-685-3733
Mailing Address - Street 1:1206 W 4TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3300
Mailing Address - Country:US
Mailing Address - Phone:307-685-3733
Mailing Address - Fax:
Practice Address - Street 1:1206 W 4TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3300
Practice Address - Country:US
Practice Address - Phone:307-685-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care