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Organization
WYOMING SURGICAL CENTER LLC
Active
Organization
WYOMING SURGICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES ROBERTSON (ADMINISTRATOR)
(307) 472-8781
Entity
Organization
Contact information
Practice address
4140 CENTENNIAL HILLS BLVD, #C, CASPER, WY 82609
(307) 472-8781
(307) 472-8887
Mailing address
4140 CENTENNIAL HILLS BLVD, #C, CASPER, WY 82609
(307) 472-8781
(307) 472-8887
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
08 012
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116664600
—
WY
01
—
310945
BLUE CROSS BLUE SHIELD OF WYOMING
WY
01
—
490005195
RAILROAD MEDICARE
WY
Enumeration date
03/31/2006
Last updated
05/13/2008
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