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JAMES ROBERT REVENAUGH
555 E BROADWAY AVE 229 ST JOHN'S MEDICAL CENTER SURGERY JACKSON WY 830018640
JAMES ROBERT REVENAUGH is physician registered in the Centers for Medicare & Medicaid Services (CMS). The National Provider Identifier (NPI) of the National Plan and Provider Enumeration System (NPPES) is 1316915952. The unique individual professional ID assigned by Provider Enrollment, Chain, and Ownership System (PECOS) is 6800864729. The primary specialty is CARDIOVASCULAR DISEASE (CARDIOLOGY). The organization is TETON COUNTY HOSPITAL DISTRICT. The address is 555 E BROADWAY AVE, 229 ST JOHN'S MEDICAL CENTER SURGERY, JACKSON, WY, 830018640. The zip code is 830018640.
|Nation Provider ID||1316915952|
|PAC ID by PECOS||6800864729|
|Professional Enrollment ID||I20051118000537|
|Name||JAMES ROBERT REVENAUGH|
|Medical School Name||NORTHWESTERN UNIVERSITY MEDICAL SCHOOL|
|Primary Specialty||CARDIOVASCULAR DISEASE (CARDIOLOGY)|
|All secondary specialties|
|Organization Name||TETON COUNTY HOSPITAL DISTRICT|
|Group Practice PAC ID||4880582295|
|Number of Group Practice members||53|
|Address||555 E BROADWAY AVE, 229 ST JOHN'S MEDICAL CENTER SURGERY, JACKSON, WY, 830018640|
|Hospital affiliation LBN||IHC HEALTH SERVICES INC|