1770566200 NPI number — WYOMING OSTEOPOROSIS CENTER LLC

Table of content: (NPI 1770566200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770566200 NPI number — WYOMING OSTEOPOROSIS CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WYOMING OSTEOPOROSIS CENTER LLC
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:
1770566200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
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:
STE. 106
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82601-3237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-577-4276
Provider Business Mailing Address Fax Number:
307-577-4278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
940 E 3RD ST
Provider Second Line Business Practice Location Address:
STE. 106
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82601-3237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-577-4276
Provider Business Practice Location Address Fax Number:
307-577-4278
Provider Enumeration Date:
11/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ELMORE
Authorized Official First Name:
RITA
Authorized Official Middle Name:
GAIL
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
307-577-4276

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , 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)

  • Identifier: 112519200 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01043001 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




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