1154622355 NPI number — UNIVERSITY OF WYOMING - WYOMING INSTITUTE FOR DISABILITIES

Table of content: (NPI 1003821232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154622355 NPI number — UNIVERSITY OF WYOMING - WYOMING INSTITUTE FOR DISABILITIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF WYOMING - WYOMING INSTITUTE FOR DISABILITIES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154622355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 E UNIVERSITY AVE
Provider Second Line Business Mailing Address:
UNIVERSITY OF WYOMING, DEPT. 4298
Provider Business Mailing Address City Name:
LARAMIE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82071-2000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-766-2761
Provider Business Mailing Address Fax Number:
307-766-2763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
UNIVERSITY OF WYOMING, DEPT. 4298
Provider Business Practice Location Address City Name:
LARAMIE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82071-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-766-2761
Provider Business Practice Location Address Fax Number:
307-766-2763
Provider Enumeration Date:
11/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MACLEAN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
E
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
307-766-2761

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  287 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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