# NORTHEAST WYOMING PEDIATRIC ASSOCIATES, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114998259
- **Authorized official:** DR. SUZANNE OSS M.D. (PRESIDENT)
- **Authorized official phone:** (307) 675-5555

## Contact information

- **Practice address:** 916 JACKSON AVE, SHERIDAN, WY 82801-2708
- **Practice address phone:** (307) 675-5555
- **Practice address fax:** (307) 675-5599
- **Mailing address:** 916 JACKSON AVE, SHERIDAN, WY 82801-2708
- **Mailing address phone:** (307) 675-5555
- **Mailing address fax:** (307) 675-5599

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NULL | Yes |
| 208000000X | Pediatrics Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/27/2006
- **Last updated:** 09/10/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000405665 | — | MT |
| 01 | — | 00941001 | BC BS WY | WY |
| 05 | — | 100048900 | — | WY |
| 05 | — | 7705130 | — | SD |