1194721050 NPI number — HIGH PLAINS SURGICAL ASSOCIATES, P.C.

Table of content: (NPI 1194721050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194721050 NPI number — HIGH PLAINS SURGICAL ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGH PLAINS SURGICAL ASSOCIATES, P.C.
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:
1194721050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1272
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILLETTE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82717-1272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-682-7555
Provider Business Mailing Address Fax Number:
307-687-7243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 W LAKEWAY RD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILLETTE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82718-6373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-682-7555
Provider Business Practice Location Address Fax Number:
307-687-7243
Provider Enumeration Date:
06/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HARTSAW
Authorized Official First Name:
SARA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
307-682-7555

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HAR308412 . This is a "BLUE CROSS" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




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