Organization
WYOMING SURGICAL CENTER MRI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES ROBERTSON (ADMINISTRATOR)
(307) 472-8781
Entity
Organization
Contact information
Practice address
4140 CENTENNIAL HILLS BLVD, #C, CASPER, WY 82609-3265
(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
2085R0202X
Diagnostic Radiology Physician
Primary
35-2-904
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00092902
RAILROAD MEDICARE
WY
01
—
WY00549
BLUE CROSS BLUE SHIELD OF WYOMING
WY
Enumeration date
11/30/2006
Last updated
07/07/2008
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