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MOUNTAIN SAGE HOLISTIC CLINIC, LLC
NPI 1376924621
Nurse Practitioner - Primary Care in Dubois, WY

Active since June 12, 2015
1428 WARM SPRINGS DR, DUBOIS, WY 82513(307) 455-2807(307) 455-2809 Get Directions Write a Review

NPPES record last updated: June 12, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mountain Sage Holistic Clinic, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOUNTAIN SAGE HOLISTIC CLINIC, LLC (NPI 1376924621) is a healthcare organization registered as a primary care in Dubois, Wyoming and active in the NPI registry since June 2015. The organization lists Martin P Baum, Business Manager, as its authorized official.

NPPES Registry Identity

NPI1376924621
Entity TypeOrganization
Primary Taxonomy363LP2300X
Legal Business NameMOUNTAIN SAGE HOLISTIC CLINIC, LLC
Location Address1428 WARM SPRINGS DRDubois, WY 82513-1428
Mailing Address1428 Warm Springs DrDubois, WY 82513-1428 · (307) 455-2807 · Fax (307) 455-2809
Phone(307) 455-2807
Fax(307) 455-2809
Organization SubpartNo
Authorized OfficialMartin P BaumBusiness Manager · (307) 455-2807
Enumeration DateJune 12, 2015
✔ NPI 1376924621 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP2300X
License✔ Licensed in WY · 33105.1295
1428 WARM SPRINGS DR, Dubois, WY 82513
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Other Identifiers 1

Medicaid136115500WY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mountain Sage Holistic Clinic, LLC's NPI number?

The NPI number for Mountain Sage Holistic Clinic, LLC is 1376924621. It was assigned to this organization in the NPPES registry on June 12, 2015.

Where is Mountain Sage Holistic Clinic, LLC located?

Mountain Sage Holistic Clinic, LLC is located at 1428 Warm Springs Dr, Dubois, WY 82513. The listed phone number is (307) 455-2807.

What is Mountain Sage Holistic Clinic, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

When was this NPI record last updated?

The NPPES record for Mountain Sage Holistic Clinic, LLC was last updated on June 12, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.