# SWEETWATER UROLOGY

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

## Provider details

- **NPI number:** 1629385786
- **Authorized official:** DR. MICHAEL SUTPHIN MD (OWNER)
- **Authorized official phone:** (307) 362-4200

## Contact information

- **Practice address:** 1208 HILLTOP DR, SUITE 204, ROCK SPRINGS, WY 82901-5859
- **Practice address phone:** (307) 362-4200
- **Practice address fax:** (307) 362-5406
- **Mailing address:** 1208 HILLTOP DR, SUITE 204, ROCK SPRINGS, WY 82901-5859
- **Mailing address phone:** (307) 362-4200
- **Mailing address fax:** (307) 362-5406

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 166834-1025 | UT | — |
| 208800000X | Urology Physician | 3547A | WY | Yes |
| 208800000X | Urology Physician | G42452 | CA | — |
| 363A00000X | Physician Assistant | WY192 | WY | — |

## Other

- **Enumeration date:** 09/09/2010
- **Last updated:** 09/09/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 104849000 | — | WY |
| 01 | — | 2266 | BLUE CROSS OF WYOMING | WY |
| 01 | — | 340001047 | RAILROAD MEDICARE | WY |