1790885523 NPI number — CENTRAL WYOMING PATHOLOGISTS PC

Table of content: (NPI 1790885523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790885523 NPI number — CENTRAL WYOMING PATHOLOGISTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL WYOMING PATHOLOGISTS PC
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:
1790885523
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50460
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82605-0460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-577-5256
Provider Business Mailing Address Fax Number:
307-687-7243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1233 E 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82601-2926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-577-2198
Provider Business Practice Location Address Fax Number:
307-687-7243
Provider Enumeration Date:
09/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STINSON
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
307-577-2198

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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