Organization
FREMONT ANESTHESIA ASSOCIATE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW A MULLINIX CRNA (MANAGING GROUP MEMBER)
(307) 856-4161
Entity
Organization
Contact information
Practice address
2100 W SUNSET DR, RIVERTON, WY 82501-2274
(800) 967-1646
(317) 567-2191
Mailing address
PO BOX 30918, BILLINGS, MT 59116-0918
(317) 567-2180
(317) 567-2191
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
WY
367500000X
Certified Registered Nurse Anesthetist
Primary
—
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06208001
BCBS
WY
05
—
1053508564
—
WY
01
—
DG4268
RAILROAD MEDICARE
WY
Enumeration date
09/28/2007
Last updated
11/25/2009
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