# WYOMING SURGICAL CENTER LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1942261573
- **Authorized official:** CHARLES ROBERTSON (ADMINISTRATOR)
- **Authorized official phone:** (307) 472-8781

## Contact information

- **Practice address:** 4140 CENTENNIAL HILLS BLVD, \#C, CASPER, WY 82609
- **Practice address phone:** (307) 472-8781
- **Practice address fax:** (307) 472-8887
- **Mailing address:** 4140 CENTENNIAL HILLS BLVD, \#C, CASPER, WY 82609
- **Mailing address phone:** (307) 472-8781
- **Mailing address fax:** (307) 472-8887

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 08 012 | WY | Yes |

## Other

- **Enumeration date:** 03/31/2006
- **Last updated:** 05/13/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 116664600 | — | WY |
| 01 | — | 310945 | BLUE CROSS BLUE SHIELD OF WYOMING | WY |
| 01 | — | 490005195 | RAILROAD MEDICARE | WY |