Organization
EVANSTON SURGICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL J O'CONNOR (OWNER/MD)
(307) 789-1390
Entity
Organization
Contact information
Practice address
196 ARROWHEAD DR, SUITE 8, EVANSTON, WY 82930-8752
(307) 789-1390
(307) 789-1391
Mailing address
196 ARROWHEAD DR, SUITE 8, EVANSTON, WY 82930-8752
(435) 613-9500
(435) 613-9414
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
5079A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952367450
—
WY
Enumeration date
04/25/2008
Last updated
10/20/2008
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