# UROLOGICAL SERVICES OF NORTHERN WYOMING PROFESSIONAL CORPORATION

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

## Provider details

- **NPI number:** 1508832080
- **Authorized official:** GREGORY S STEWART M.D. (OWNER)
- **Authorized official phone:** (307) 587-5131

## Contact information

- **Practice address:** 225 W YELLOWSTONE AVE, SUITE \#9, CODY, WY 82414-8702
- **Practice address phone:** (307) 587-5131
- **Practice address fax:** (307) 587-5132
- **Mailing address:** 225 W YELLOWSTONE AVE, CODY, WY 82414-8702
- **Mailing address phone:** (307) 587-5131
- **Mailing address fax:** (307) 587-5132

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 7308A | WY | Yes |

## Other

- **Enumeration date:** 02/24/2006
- **Last updated:** 04/26/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 122121300 | — | WY |
| 01 | — | 314014 | BLUE CROSS BLUE SHIELD | WY |
| 01 | — | 611975900 | FEDERAL WORK COMP | — |
| 01 | — | DF1105 | RAILROAD MEDICARE | — |