# CHEYENNE MEDICAL PLAZA SURGERY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Yellowstone Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902803158
- **Authorized official:** DR. TAKE GEORGE PULLOS M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (307) 635-7070

## Contact information

- **Practice address:** 2301 HOUSE AVE, \#200, CHEYENNE, WY 82001-3176
- **Practice address phone:** (307) 635-7070
- **Practice address fax:** (307) 433-9311
- **Mailing address:** 2301 HOUSE AVE, \#200, CHEYENNE, WY 82001-3176
- **Mailing address phone:** (307) 635-7070
- **Mailing address fax:** (307) 433-9311

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 06-186 | WY | Yes |

## Other

- **Enumeration date:** 07/02/2005
- **Last updated:** 08/22/2020