1871803874 NPI number — CY EDWARDS MD OF WY, PC

Table of content: (NPI 1871803874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871803874 NPI number — CY EDWARDS MD OF WY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CY EDWARDS MD OF WY, 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:
ALL WOMENS CARE
Provider Other Organization Name Type Code:
3
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:
1871803874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
940 E 3RD ST.
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82601-3251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-235-0000
Provider Business Mailing Address Fax Number:
307-235-0019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
940 E 3RD ST.
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82601-3251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-235-0000
Provider Business Practice Location Address Fax Number:
307-235-0019
Provider Enumeration Date:
10/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
307-235-0000

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4301081097 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 12986 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: 7878A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: OE27609028 . This is a "MEDICARE OTHER NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 147761470 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: CE081097 . This is a "BCBS ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104482347 . This is a "OTHER MEDICARE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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