Pinedale Medical Clinic – Family Medicine Physician, NPI 1104410596
Family Medicine Physician
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Pinedale Medical Clinic
625 E HENNICK ST
PINEDALE, WY 829415228
Phone: (307) 367-4133
Type: Location
PO BOX 627
PINEDALE, WY 829410627
Phone: (307) 367-0021
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-05-18
PECOS data refreshed: 2026-05-27
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 82941)
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