1407942501 NPI number — WESTERN WYOMING NEUROLOGY PC

Table of content: (NPI 1407942501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407942501 NPI number — WESTERN WYOMING NEUROLOGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN WYOMING NEUROLOGY 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:
1407942501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 970488
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OREM
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84097-0488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-473-7035
Provider Business Mailing Address Fax Number:
801-607-1467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2751 COMMERCIAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK SPRINGS
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82901-4753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-382-6199
Provider Business Practice Location Address Fax Number:
307-382-6449
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WATKINS
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
801-473-7035

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  7246A , 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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