1992866560 NPI number — WYOMING CARDIOPULMONARY SERVICES, PC

Table of content: (NPI 1992866560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992866560 NPI number — WYOMING CARDIOPULMONARY SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WYOMING CARDIOPULMONARY SERVICES, 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:
1992866560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1230 E 1ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82601-2704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-266-3174
Provider Business Mailing Address Fax Number:
307-261-6713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1230 E 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82601-2704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-266-3174
Provider Business Practice Location Address Fax Number:
307-261-6713
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NOVICK
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
307-266-3174

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 106386300 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00780001 . This is a "BCBS GROUP ID" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




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