# KODIAK ANESTHESIA PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Matthew D.Chynoweth
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295138972
- **Authorized official:** DR. MATTHEW D CHYNOWETH (PRESIDENT)
- **Authorized official phone:** (307) 473-8173

## Contact information

- **Practice address:** 4850 CHINOOK TRL, CASPER, WY 82604-5201
- **Practice address phone:** (307) 473-8173
- **Mailing address:** 4850 CHINOOK TRL, CASPER, WY 82604-5201
- **Mailing address phone:** (307) 473-8173

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 7192A | WY | Yes |

## Other

- **Enumeration date:** 10/08/2014
- **Last updated:** 12/04/2019