1508832080 NPI number — UROLOGICAL SERVICES OF NORTHERN WYOMING PROFESSIONAL CORPORATION

Table of content: DR. JOHN T. KING D.M.D. (NPI 1538227277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508832080 NPI number — UROLOGICAL SERVICES OF NORTHERN WYOMING PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UROLOGICAL SERVICES OF NORTHERN WYOMING PROFESSIONAL CORPORATION
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:
1508832080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 W YELLOWSTONE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CODY
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82414-8702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-587-5131
Provider Business Mailing Address Fax Number:
307-587-5132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 W YELLOWSTONE AVE
Provider Second Line Business Practice Location Address:
SUITE #9
Provider Business Practice Location Address City Name:
CODY
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82414-8702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-587-5131
Provider Business Practice Location Address Fax Number:
307-587-5132
Provider Enumeration Date:
02/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEWART
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
307-587-5131

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  7308A , 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: DF1105 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 122121300 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 611975900 . This is a "FEDERAL WORK COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 314014 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com